Surgical complications in COVID-19 patients in the setting of moderate to severe disease

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.

Keywords: Acute respiratory distress syndrome; COVID-19; Mortality rate; SARS-CoV-2; Surgery; Surgery complications; Thrombosis.

Figure 1

Histology examination. A: Hyaline membranes (marked with an arrow) covering the alveolar walls in a case of septic acute respiratory distress syndrome originating from gangrenous appendicitis in coronavirus disease-2019 patient; B: Microthrombosis resulted in almost complete obstruction of the pulmonary vessel; C: Diffuse alveolar damage with interalveolar hemorrhages and inflammatory cell infiltration, as well as type II hyperplastic pneumocyte (marked with an arrow); D-G: Septicopyemic abscess in the spleen (D, marked with an arrow), kidney (E, marked with an arrow), brain (F, marked with an arrow) and myocardium (G, marked with an arrow); E: Acute tubular necrosis found.