Clinical characteristics of emergency surgery patients infected with coronavirus disease 2019 (COVID-19) pneumonia in Wuhan, China

Abstract

Background: We aimed to investigate clinical symptoms and epidemiologic features of emergency surgery patients infected with the 2019 novel coronavirus disease (COVID-19). More than 5 million people worldwide have been diagnosed with COVID-19 since December 2019 to the time of this publication. Thousands of emergency operations have been carried out since December 2019. To date, however, no literature has focused on the clinical symptoms of emergency surgery patients with COVID-19 pneumonia.

Methods: We conducted a retrospective cohort study of 164 emergency surgery patients with or without COVID-19 pneumonia in Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1, 2020, to January 20, 2020. For this report, the final date of follow-up was February 5, 2020. The associated clinical, laboratory, epidemiologic, demographic, radiologic, and outcome data were collected and analyzed.

Results: Of the 164 emergency surgery patients, the median age was 41 years (interquartile range, 29-89), and 136 (82.9%) were women. The associated main clinical symptom included fever (93 [56.7%])，dry cough (56 [34.2%]), fatigue (86 [52.4%]), nausea (78 [47.6%]), and dizziness (77 [47%]). Of 54 emergency surgery patients infected with COVID-19, the median age was 46 years (interquartile range: 25-89), and 45 (83.3%) were women. The pathologic clinical symptoms investigated included fever (54 [100%]), fatigue (48 [88.9%]), nausea (52 [96.3%]), dizziness (46 [85.2%]), and dry cough (44 [81.5%]). The lymphopenia (0.37 × 10⁹/L [interquartile range: 0.23-0.65]) and increased C-reactive protein (24.7 × 10⁹/L [interquartile range: 13.57-38]) were observed. The preoperative fever and postoperative fever in emergency surgery patients with or without COVID-19 pneumonia were analyzed in this study. Of 54 emergency surgery patients with COVID-19, 15 (27.8%) showed preoperative fever, 54 (100%) had postoperative fever. Of 110 emergency surgery patients without COVID-19, 5 (4.5%) had preoperative fever, 31 (28.2%) patients had postoperative fever. In emergency surgery patients with COVID-19, the fever lasted more than 7 days, markedly exceeded the length of time non-COVID-19 patients experienced fever (approximately 3 days). Furthermore, 43 health care workers were exposed to emergency surgery patients with COVID-19 pneumonia and were infected with COVID-19 pneumonia.

Conclusion: In our study, the clinical symptoms of emergency surgery patients infected with COVID-19 displayed marked differences from those reporting common COVID-19 pneumonia. In addition, the health care workers were suspected to have been exposed to a great risk when caring for emergency surgery patients with COVID-19 pneumonia. Management guidelines of emergency surgery patients are described in in this report.

Fig 1

Dynamic profile of postoperative fever in ESPs with or without the COVID-19 pneumonia infection. (A) The duration of postoperative fever between patients with the COVID-19 pneumonia infection and patients with no COVID-19 pneumonia infection. (B) The body temperature of ESPs with or with no COVID-19 pneumonia infection. The 2019 novel coronavirus disease was designated as COVID-19 here (∗P < .05, ^†P < .01).

Fig 2

Transverse chest CT images. (A-C) Chest CT images of ESPs with the COVID-19 infection who displayed marked ground glass opacity in both lungs. (D-F) Transverse chest CT images of ESPs with no COVID-19 infection. The 2019 novel coronavirus disease was designated as COVID-19 here (∗P < .05, ^†P < .01).

Fig 3

Guide for emergency surgery during COVID-19. Patients in need of emergency surgery had to be tested for COVID-19; however, critically ill patients were resuscitated regardless of health care worker protective equipment. All patients who tested positive for or were suspected positive for COIVD-19 or were critically ill were operated on in a negative pressure operating room. In addition, the surgeons performed surgery while using three-level protection. All patients were required to be retested for COVID-19 pneumonia after their operations.