Perioperative fatal thrombotic complication after elective meningioma resection in asymptomatic SARS-CoV-2 BA.5.2 (Omicron variant) infection

Abstract

SARS-CoV-2 infection is associated with hypercoagulability, heparin resistance, and increased perioperative mortality and morbidity. Recommendations on screening and postponement of elective surgery after SARS-CoV-2 infection are being relaxed worldwide. We present a case of fatal thrombotic complication in an asymptomatic incidental SARS-CoV-2 infection (Omicron BA.5.2 variant, first isolated in May 2022) in a triple-vaccinated patient undergoing elective resection of frontal meningioma. The assumption that asymptomatic infection with more recent SARS-CoV-2 variants does not add any perioperative risk remains to be demonstrated. Based on the presented case of unexpected fatal thrombotic perioperative complication in a triple-vaccinated, asymptomatic BA.5.2 SARS-CoV-2 Omicron infection, it would seem prudent to continue to screen for asymptomatic infection and to systematically audit perioperative outcome. Evidence-based perioperative risk stratification of elective surgery in asymptomatic patients with Omicron or future COVID variants relies on reporting of perioperative complications and prospective outcome studies, which would rely on continued systematic preoperative screening.

Keywords: SARS-CoV-2; elective surgery; neuroanaesthesia; perioperative death; thrombosis.

Figure 1

(a) Preoperative MRI: 5 cm right frontal meningioma with associated oedema. (b) Postoperative CT (Day 0): unexpected left frontal haemorrhagic infarct likely to represent venous infarction and new posterior circulation bilateral hypodensities. (c) Postoperative CT (Day 5): evolution of multifocal infarcts with obliterated basal cisterns and sulci, and uncal herniation.