Evaluation of perioperative safety of lung surgery for patients with COVID-19_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Wenxin , SUN Yaoguang , WU Qingjun , MA Chao , JIAO Peng , YU Hanbo , HUANG Chuan , LI Donghang , TIAN Yi ,  TONG Hongfeng

Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China;

Corresponding author：

TONG Hongfeng, Email: georgetwx@163.com

Keywords：

Corona virus disease 2019 (COVID-19 ); lung surgery; perioperative complications; risk factor

DOI：

10.7507/1007-4848.202307052

Video：

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Objective To evaluate the perioperative safety of lung surgery for patients with corona virus disease 2019 (COVID-19). Methods We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital. Patients who received lung surgery and without COVID-19 at the same time were selected as a control group. Perioperative data between the two groups were compared. Results A total of 103 patients were included with 44 males and 49 females at an average age of (62.2±12.1) years. All surgeries were performed by uniportal video-assisted thoracoscopic surgery (VATS). Among patients who recovered from COVID-19, 53 (51.5%) received lobectomy, 30 (29.1%) received segmentectomy, and 20 (19.4%) received wedge resection. The interval between diagnosis of infection and lung surgery was ≤1 month in 32 (31.1%) patients, and >1 month in 71 (68.9%) patients. The results of virus nucleic acid test for all patients before surgery were negative. A total of 13 (12.6%) patients had positive IgM, and 100 (97.1%) patients had positive IgG. A total of 20 patients experienced perioperative complications (13 patients with pulmonary air leakage, 3 patients with chylothorax, 2 patients with atrial fibrillation, and 2 patients with severe pulmonary complications). There was one perioperative death. Comparing the patients who recovered from COVID-19 with those without COVID-19, we found no statistical difference in perioperative outcomes including surgical duration, postoperative drainage, duration of thoracic tube, and duration of postoperative stay (P>0.05). There was no significant difference in perioperative complications between the two groups (P>0.05). Multivariable logistical regression analysis demonstrated that positive IgM before surgery (OR=7.319, 95%CI 1.669 to 32.103, P=0.008), and longer duration of surgery (OR=1.016, 95%CI 1.003 to 1.028, P=0.013) were independent risk factors of perioperative complications for patients who recovered from COVID-19. Conclusion It is safe for patients recover from COVID-19 to receive lung surgery when symptoms disappear and the nucleic acid test turn negative. However, positive COVID-19 IgM is an independent risk factor for perioperative complications. We suggest that lung surgery could be performed when the nucleic acid test and COVID-19 IgM are both negative for patients recover from COVID-19 infection.

Citation： TIAN Wenxin, SUN Yaoguang, WU Qingjun, MA Chao, JIAO Peng, YU Hanbo, HUANG Chuan, LI Donghang, TIAN Yi, TONG Hongfeng. Evaluation of perioperative safety of lung surgery for patients with COVID-19. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1753-1758. doi: 10.7507/1007-4848.202307052 Copy

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1. COVIDSurg Collaborative. Outcomes and their state-level variation in patients undergoing surgery with perioperative SARS-CoV-2 infection in the USA: A prospective multicenter study. Ann Surg, 2022, 275(2): 247-251.
2. Shao CC, McLeod MC, Thogaripally S, et al. Increased risk of postoperative mortality associated with prior COVID-19 infection. Am J Prev Med, 2022, 63(1 Suppl 1): S75-S82.
3. Yilmaz S, Sapci I, Jia X, et al. Risk factors associated with postoperative mortality among COVID-19 positive patients: Results of 3027 operations and procedures. Ann Surg, 2022, 276(6): 969-974.
4. COVIDSurg Collaborative. Timing of surgery following SARSCoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
5. 李辉, 游宾, 区颂雷, 等. COVID-19疫情期间胸外科手术风险管控的几点建议. 中华胸心血管外科杂志, 2023, 39(1): 1-3.Li H, You B, Ou SL, et al. Proposal for risk control of thoracic surgery during the COVID-19 pandemic. Chin J Thorac Cardiovasc Surg, 2023, 39(1): 1-3.
6. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol, 2021, 19(3): 141-154.
7. Iwata E, Hasegawa T, Yamada SI, et al. Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: Multicenter retrospective study with propensity score matching analysis. Surg, 2019, 165(5): 1003-1007.
8. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
9. 汪建茹, 杨进波, 张驰. SARS-CoV-2抗体检测在新型冠状病毒肺炎诊断中的应用价值. 检验医学, 2020, 35(6): 546-550.Wang JR, Yang JB, Zhang C. Role of severe acute respiratory syndrome coronavirus 2 antibody detections in the diagnosis of corona virus disease 2019. Lab Med, 2020, 35(6): 546-550.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Evaluation of perioperative safety of lung surgery for patients with COVID-19

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