Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection
Open accessAbstract
BACKGROUND: The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes. METHODS: We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020. FINDINGS: Of the 34 operative patients, the median age was 55 years (IQR, 43-63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury. INTERPRETATION: In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%. FUNDING: National Natural Science Foundation of China.
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Early reports described overwhelmed hospitals in China and Italy during the COVID-19 pandemic.
“In response to the early reports of overwhelmed hospitals in China 4 and Italy, 5 the Centers for Medicare and Medicaid Services 6 and the American College of Surgeons 7 recommended a moratorium on non-emergency surgery.”
From A Nation-Wide Review of Elective Surgery and COVID-Surge Capacity (2021) · cites this paper as [4]
Citation 4 is attached to China. The Introduction and Methods describe the early outbreak in Wuhan and identify four participating hospitals, but do not say those hospitals were overwhelmed. Searches for overwhelmed hospitals and hospital capacity found no passage addressing that point; the separate citation for Italy is not assessed here. (LLM, conf=0.72)
Experimental — accuracy not yet measuredMany studies reported poor outcomes in COVID-19 patients that underwent abdominal surgery.
“Moreover, many studies reported poor outcomes in COVID-19 patients that underwent abdominal surgery [61,62].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [62]
In the pre-pandemic African Surgical Outcomes Study, ARDS occurred in 0.05% of patients.
“occurred much more frequently (20%) than reported in the pre-pandemic African Surgical Outcomes Study (0·05%).22”
From Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study (2020) · cites this paper as [22]
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- Authors
- Lei, S., Jiang, F., Su, W., Chen, C., Chen, J., Mei, W., Zhan, L.-Y., Jia, Y., Zhang, L., Liu, D., Xia, Z.-Y., & Xia, Z.
- Affiliations
- Renmin Hospital of Wuhan University (CN)
- University of Hong Kong (HK)
- Zhongnan Hospital of Wuhan University (CN)
- Central Hospital of Wuhan (CN)
- Tongji Hospital (CN)
- Guangdong Medical College (CN)
- Corresponding author
- Xia, Zhong-Yuan
- Xia, Zhengyuan
- ORCID
- Venue
- EClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 21
- Pages
- 100331
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC7128617
- OpenAlex
- W3014405676
- Cited by
- 1,415
- References
- 27
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 39 · 2023: 97 · 2022: 189 · 2021: 378 · 2020: 681 · 2019: 2 · 2012: 1
- FWCI
- 43.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by-nc-nd)
- Funders
- National Natural Science Foundation of China
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, SARS-CoV-2, elective surgery, incubation period, intensive care unit admission, mortality, acute respiratory distress syndrome, shock, cardiac arrhythmias, acute cardiac injury, lymphopenia, comorbidities, surgical outcomes
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