Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

High mortality is expected in patients who have COVID-19 during the postoperative period

Gengwen Huang
CMAJ July 20, 2020 192 (29) E847; DOI: https://doi.org/10.1503/cmaj.75781
Gengwen Huang
General surgeon, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Since coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on Mar. 11, 2020, many professional societies have recommended that elective surgeries be postponed if possible, with the goal of minimizing disease spread and maintaining health care capacity. Even so, the provision of surgery will continue to be an essential part of our health care system throughout the pandemic.1

For patients who need surgery, what is their risk if they are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) postoperatively? So far, little is known about the impact of COVID-19 on mortality in patients during the postoperative period. I searched PubMed for articles published up to May 13, 2020, using the search terms “novel coronavirus,” “2019-nCoV,” “COVID-19” or “SARS-CoV-2” with no language or time restriction. I found 3 articles including 19 patients who had COVID-19 perioperatively.2–4 Of the 19 patients, 11 were male (57.9%), and the mean age was 60.3 years. The operations included general, gynecologic and thoracic surgeries. Information about the timing of COVID-19 symptom onset was available in 12 patients; 9 patients (75%) had pneumonia symptoms within 7 days after surgery and the other 3 had symptoms more than 7 days after surgery. The case fatality rate was 36.8% (7/19).

These data suggest that patients infected with SARS-CoV-2 in the perioperative period have a high risk of death, although there may be a bias to report more severe cases. It is widely believed that the fatality of COVID-19 in the general population is less than 5%, but older age and comorbidities are indicators of poor prognosis.5 Data here suggest that postoperative patients may be another group who have a poor prognosis with COVID-19.

The median incubation period of SARS-CoV-2 has been reported to be 4 days, with a range of about 2–7 days.6 The fact that pneumonia symptoms developed in 75% of the patients within 7 days after surgery means that most of the infections may have occurred before surgery. These surgeries could have been delayed safely if SARS-CoV-2 infection had been detected before the operations. Because no vaccine or effective antiviral treatments are available, prevention is the best way to reduce the impact of COVID-19. Preoperative intensive surveillance for SARS-CoV-2 infection must be done during the pandemic. To avoid nosocomial transmission of the virus, strict isolation and protection measures should be implemented. Visitor policies should be updated simultaneously; each patient should have only 1 visitor at a time. Finally, our surgical communities should adapt to the unprecedented worldwide public health crisis to develop a COVID-19-specific approach to providing the very best care to our patients during the pandemic.

Footnotes

  • Competing interests: None declared.

References

  1. ↵
    1. Urbach DR,
    2. Martin D
    . Confronting the COVID-19 surgery crisis: time for transformational change. CMAJ 2020;192:E585–6.
    OpenUrlFREE Full Text
  2. ↵
    1. Aminian A,
    2. Safari S,
    3. Razeghian-Jahromi A,
    4. et al
    . COVID-19 outbreak and surgical practice: unexpected fatality in perioperative period. Ann Surg 2020;272:e27–9.
    OpenUrl
    1. Yang S,
    2. Zhang Y,
    3. Cai J,
    4. et al
    . Clinical characteristics of COVID-19 after gynecologic oncology surgery in three women: a retrospective review of medical records. Oncologist 2020;25:e982–5.
    OpenUrl
  3. ↵
    1. Li YK,
    2. Peng S,
    3. Li LQ,
    4. et al
    . Clinical and transmission characteristics of COVID-19: a retrospective study of 25 cases from a single thoracic surgery department. Curr Med Sci 2020;40:295–300.
    OpenUrlPubMed
  4. ↵
    1. Zhou F,
    2. Yu T,
    3. Du R,
    4. et al
    . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Guan W,
    2. Ni Z,
    3. Hu Y,
    4. et al
    . Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (29)
CMAJ
Vol. 192, Issue 29
20 Jul 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
High mortality is expected in patients who have COVID-19 during the postoperative period
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
High mortality is expected in patients who have COVID-19 during the postoperative period
Gengwen Huang
CMAJ Jul 2020, 192 (29) E847; DOI: 10.1503/cmaj.75781

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
High mortality is expected in patients who have COVID-19 during the postoperative period
Gengwen Huang
CMAJ Jul 2020, 192 (29) E847; DOI: 10.1503/cmaj.75781
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Confronting the COVID-19 surgery crisis: time for transformational change
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Highlighting obesity as a risk factor for endometrial cancer
  • Hepatitis B vaccination for Canadian children: time for an adult conversation
  • Codesigning a public health approach to preventing firearm-related suicide deaths with rural communities
Show more Letters

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire