Clinical Course of Three Postoperative Symptomatic COVID-19 Cases in Patients After Lung Lobectomy

Perioperative Management of a Patient With Multiple Comorbidities Undergoing Lung Resection for Bronchopulmonary Carcinoid Complicated by SARS-CoV-2 Infection: A Case Report

We report a case of a high-risk patient with multiple comorbidities who underwent right median lobectomy and lymph node resection due to a carcinoid tumor. The patient's course was complicated by a hospital-acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a postoperative chest hematoma requiring urgent thoracotomy. Multidisciplinary and timely management resulted in a favorable patient outcome.

COVID-19 after Thoracotomy in Patients with Pulmonary Hydatidosis

Hydatidosis is one of the most important parasitic and zoonotic endemic infections caused by the larvae of cestode Echinococcus granulosus. Co-infection of hydatid cyst with the coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has been previously reported. The mortality rate of hydatidosis is reported to be 2-4% and the liver and lungs are the two most commonly involved organs, respectively. In the present study, we have reported two recovered pulmonary hydatidosis patients who were infected with SARS-CoV-2 after thoracotomy in the hospital. In general, current cases suggest that patients with thoracic surgery are more likely to develop severe infection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). The patients presented COVID-19 symptoms shortly after thoracotomy and their viral tests were confirmed with the positive result of SARS-CoV-2 RT-PCR. In conclusion, possible differential diagnoses should be considered in similar cases and adequate attention should be paid to intraoperative and postoperative care.

Prevention of COVID-19 in Thoracic Surgery Patients: Lessons Learned during the First Pandemic Wave

BACKGROUND

 The aim of this retrospective study was to investigate the implementation of measures to prevent perioperative COVID-19 in thoracic surgery during the first wave of the COVID-19 pandemic 2020 allowing a continued surgical treatment of patients.

METHODS

 The implemented preventive measures in patient management of the thoracic surgery department of the Asklepios Lung Clinic Munich-Gauting, Germany were retrospectively analyzed. Postoperative COVID-19 incidence before and after implementation of preventive measures was investigated. Patients admitted for thoracic surgical procedures between March and May 2020 were included in the study. Patient characteristics were analyzed. For the early detection of putative postoperative COVID-19 symptoms, typical post-discharge symptomatology of thoracic surgery patients was compared to non-surgical patients hospitalized for COVID-19.

RESULTS

 Thirty-five surgical procedures and fifty-seven surgical procedures were performed before and after implementation of the preventive measures, respectively. Three patients undergoing thoracic surgery before implementation of preventive measures developed a COVID-19 pneumonia post-discharge. After implementation of preventive measures, no postoperative COVID-19 cases were identified. Fever, dyspnea, dry cough and diarrhea were significantly more prevalent in COVID-19 patients compared to normally recovering thoracic surgery patients, while anosmia, phlegm, low energy levels, body ache and nausea were similarly frequent in both groups.

CONCLUSIONS

 Based on the lessons learned during the first pandemic wave, we here provide a blueprint for successful easily implementable preventive measures minimizing SARS-CoV-2 transmission to thoracic surgery patients perioperatively. While symptoms of COVID-19 and the normal postoperative course of thoracic surgery patients substantially overlap, we found dyspnea, fever, cough, and diarrhea significantly more prevalent in COVID-19 patients than in normally recovering thoracic surgery patients. These symptoms should trigger further diagnostic testing for postoperative COVID-19 in thoracic surgery patients.

COVID-19 After Lung Resection in Northern Italy

We reviewed surgical cases from 4 Thoracic Surgery departments in the Lombardia region of Italy, the area mostly affected by Coronavirus pandemic in Europe, with the aim to describe the impact of COVID-19 on the treatment of thoracic surgical patients. Clinical, radiological and laboratory data from patients who underwent lung resection from December 2019 to March 2020 were retrospectively collected until June 2020. Univariable Cox regression models were estimated to evaluate potential prognostic factors for developing COVID-19 and to investigate postoperative mortality among patients who developed symptomatic COVID-19 infection. We examined data from 107 patients. (74 lobectomies, 32 wedge/segmentectomies and 1 pneumonectomy). Twelve patients developed COVID-19 (Group 1), whereas 95 patients were not infected (Group 2). In Group 1, 6 patients (50%) died from complications related to infection; in Group 2, one patient (1%) died because of non-COVID-19-related causes. Median days from surgery to first symptoms, CT confirmation, clinical confirmation and PCR positivity was 48.1, 54.3, 55.1, and 55.2 respectively. At univariable analysis, DLCO/VA% (P = 0.008), duration of the surgery (P = 0.009), smoking history (pack/year) (P < 0.001), BMI (P< 0.001) and number of segments resected (P = 0.010) were associated with COVID-19 onset. Moreover, CCI (P < 0.001), DLCO/VA% (P = 0.002), cigarette pack/year (P < 0.001), BMI (P < 0.001) and COVID-19 (P < 0.001) were associated with death. Patients who undergo lung resection and then develop symptomatic COVID-19 infection are at higher risk of developing severe respiratory complications and postoperative death. Insidious symptoms’ onset may lead to a delay in diagnosis. We suggest two mitigating strategies: (1) Improve symptoms surveillance and isolation during recovery period, (2) Be aware of a potential greater risk of developing symptomatic COVID-19 and death correlated with elevated CCI, BMI, smoking history, DLCO/VA%, number of resected segments and duration of surgery.

SARS-COV-2 infection in the perioperative of pulmonary lobectomy. About a case

Objective

To describe the form of severe clinical presentation of SARS-COV-2 infection in the early phase, also the timely treatment of COVID-19 pneumonia in postoperative pulmonary lobectomy.

Method

Case report where the data were extracted from the clinical history and is in accordance with the SCARE 2018 criteria.

Description of the case

A 36-year-old man, with no significant history, who presented fever and mucopurulent expectoration of 1 month of evolution, received antibiotics for 4 weeks without response to treatment. Chest tomography shows cystic image with heterogeneous content in the left lower lobe. We decided to opt for surgery, previously 1 PCR in RT and 7 serological tests for COVID-19 were performed, the result of which was non-reactive. In the postoperative period, the patient developed fever and dyspnea on mild exertion, so a new serological test for COVID-19 was performed: IgM/IgG reactive, in addition chest tomography showed both lungs with "cracy paving" pattern.

Discussion

The serological tests did not contribute to a timely diagnosis of COVID-19 and generated confusion. We used oxygen therapy, broad spectrum antibiotics since the diagnosis of COVID-19. Likewise, respiratory physiotherapy was intensified even after discharge.

Conclusion

The early diagnosis and use of antibiotics at doses of sepsis, associated with corticosteroid pulses and respiratory physiotherapy improve COVID-19 pneumonia in postoperative lung surgery.