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Bubberman JM, Claessen J, Feijen MMW, Meesters-Caberg MAJ, Van Kuijk SMJ, Van der Hulst RRWJ, Tuinder SMH. COVID-associated complications after reconstructive breast surgery: a retrospective cohort study. Breast Cancer Res Treat 2023; 202:257-265. [PMID: 37507518 PMCID: PMC10505595 DOI: 10.1007/s10549-023-07064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE The COVID pandemic significantly influenced reconstructive breast surgery regimens. Many surgeries were cancelled or postponed. COVID entails not only respiratory, but also coagulative symptoms. It, therefore, potentially increases the risk of postoperative complications. The incidence of perioperative COVID infection and its influence on postoperative recovery after reconstructive breast surgery is still unknown. METHODS This dual center retrospective cohort study included patients that underwent reconstructive breast surgery between March 2020 and July 2021. Post-mastectomy autologous or implant-based breast reconstruction (ABR; IBR), as well as post-lumpectomy oncoplastic partial breast reconstruction (PBR) were eligible. Patient data were extracted from electronic medical records. Data regarding COVID-19 infection was collected through a questionnaire. The primary outcome was complication rate. RESULTS The ABR, IBR and PBR groups consisted of 113 (12 COVID-positive), 41 (2 COVID-positive) and 113 (10 COVID-positive) patients. In the ABR and PBR groups, postoperative complications occurred significantly more often in patients with perioperative COVID-infection. Especially impaired wound healing occurred significantly more often in the ABR and PBR breasts, but also at the donor site of ABR patients with perioperative COVID. CONCLUSION Perioperative COVID-infection increases susceptibility to complicated wound healing after reconstructive breast surgery. A possible explanation lies in the dysregulation of haemostasis by the virus, and its direct effects on microvasculature. A hypercoagulable state results. We recommend to postpone elective breast surgery for 4-6 weeks after COVID-19 infection. Also, precautionary measures remain important to minimize the risk of perioperative COVID-19 infection.
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Affiliation(s)
- J M Bubberman
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Claessen
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - M M W Feijen
- Department of Plastic, Reconstructive and Hand Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - M A J Meesters-Caberg
- Department of Plastic, Reconstructive and Hand Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - S M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R R W J Van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S M H Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Gupta AK, Leslie A, Hewitt JN, Kovoor JG, Ovenden CD, Edwards S, Chan JCY, Worthington MG. Cardiac surgery on patients with COVID-19: a systematic review and meta-analysis. ANZ J Surg 2022; 92:1007-1014. [PMID: 35373439 PMCID: PMC9111466 DOI: 10.1111/ans.17667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022]
Abstract
Introduction The COVID‐19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS‐CoV‐2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta‐analysis aiming to characterize outcomes of COVID‐19 positive patients undergoing cardiac surgery. Methods The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID‐19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta‐analysis was conducted using a random‐effects model where at least two studies had sufficient data for that variable. Results Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion This systematic review and meta‐analysis investigated studies of limited quality which characterized cardiac surgery in COVID‐19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID‐19 on decision‐making in cardiac surgery, and effects of COVID‐19 on the cardiovascular system at a cellular level.
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Affiliation(s)
- Aashray K Gupta
- Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alasdair Leslie
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin C Y Chan
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Gomes WJ, Rocco I, Pimentel WS, Pinheiro AHB, Souza PMS, Costa LAA, Teixeira MMP, Ohashi LP, Bublitz C, Begot I, Moreira RSL, Hossne NA, Vargas GF, Branco JNR, Teles CA, Medeiros EAS, Sáfadi C, Rampinelli A, Moratelli L, Rosado AR, Mesacasa FK, Capriata IE, Segalote RC, Palmieri DLDRV, Jardim ACM, Vianna DS, Coutinho JHDSA, Jazbik JC, Coutinho HMDR, Kikuta G, Almeida ZSMD, Feguri GR, Lima PRLD, Franco AC, Borges DDC, Cruz FRHDL, Croti UA, Borim BC, Marchi CHD, Goraieb L, Postigo KBS, Jucá FG, Oliveira FRDA, Souza RBD, Zilli AC, Mas RGS, Bettiati LC, Tranchesi R, Bertini A, Franco LV, Fernandes P, Oliveira F, Moraes R, Araújo TCVND, Braga OP, Pedrosa AC, Teixeira RTB, Camboim ILL, Gomes EN, Reis PH, Garcia LP, Scorsioni NHG, Lago R, Guizilini S. COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience. Braz J Cardiovasc Surg 2021; 36:725-735. [PMID: 34882365 PMCID: PMC8641779 DOI: 10.21470/1678-9741-2021-0960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. METHODS A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. RESULTS The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. CONCLUSION COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.
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Affiliation(s)
- Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Cardiology Postgraduate Program, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isadora Rocco
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Cardiology Postgraduate Program, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Wallace S Pimentel
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Aislan H B Pinheiro
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo M S Souza
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz A A Costa
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marjory M P Teixeira
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Leonardo P Ohashi
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Caroline Bublitz
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isis Begot
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Rita Simone L Moreira
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil. 4Sociedade Brasileira de Cirurgia Cardiovascular, São Paulo, São Paulo, Brazil
| | - Nelson A Hossne
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Guilherme F Vargas
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - João Nelson R Branco
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos A Teles
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Eduardo A S Medeiros
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Camila Sáfadi
- Sociedade Brasileira de Cirurgia Cardiovascular, São Paulo, São Paulo, Brazil
| | - Amândio Rampinelli
- Instituto de Cardiologia de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Leopoldo Moratelli
- Instituto de Cardiologia de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anderson Rosa Rosado
- Instituto de Cardiologia de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | | | - Diego Sarty Vianna
- Instituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - João Carlos Jazbik
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Gustavo Kikuta
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Gibran Roder Feguri
- Hospital Geral Filantrópico Universitário de Cuiabá, Cuiabá, Mato Grosso, Brazil
| | | | - Anna Carolina Franco
- Hospital Geral Filantrópico Universitário de Cuiabá, Cuiabá, Mato Grosso, Brazil
| | | | | | - Ulisses Alexandre Croti
- Pediatric Cardiology and Cardiovascular Surgery Service at Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Bruna Cury Borim
- Pediatric Cardiology and Cardiovascular Surgery Service at Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Carlos Henrique De Marchi
- Pediatric Cardiology and Cardiovascular Surgery Service at Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Lilian Goraieb
- Pediatric Cardiology and Cardiovascular Surgery Service at Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Karolyne Barroca Sanches Postigo
- Pediatric Cardiology and Cardiovascular Surgery Service at Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | | | | | | | | | | | - Ricardo Tranchesi
- Hospital de Caridade São Vicente de Paulo, Jundiaí, São Paulo, Brazil
| | - Ayrton Bertini
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | | | | | - Fabiana Oliveira
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | - Roberto Moraes
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | | | | | | | | | | | | | - Pedro Horigushi Reis
- Hospital Regional de Sorocaba Dr. Adib Domingos Jatene, Sorocaba, São Paulo, Brazil
| | - Luara Piovan Garcia
- Hospital Regional de Sorocaba Dr. Adib Domingos Jatene, Sorocaba, São Paulo, Brazil
| | | | - Roberto Lago
- Hospital Regional de Sorocaba Dr. Adib Domingos Jatene, Sorocaba, São Paulo, Brazil
| | - Solange Guizilini
- Cardiology and Cardiovascular Surgery Disciplines, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Cardiology Postgraduate Program, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Khalil KH, Sá MPBO, Vervoort D, Roever L, Pires MADA, Lima JMDO, de Salles FB, Khalil GM, Nicz PFG, Mejía OAV, Okino AA, Lima RDC. Impact of the COVID-19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective. J Card Surg 2021; 36:3289-3293. [PMID: 34148261 PMCID: PMC8447419 DOI: 10.1111/jocs.15765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has been a worldwide challenge, and efforts to "flatten the curve," including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. METHODS This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. RESULTS We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central-west regions. CONCLUSION The COVID-19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID-19 cases. There was also an increase in the national CABG death rate.
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Affiliation(s)
- Kalil Hussein Khalil
- Department of Cardiovascular Surgery, Hospital Norte Paranaense, Jardim Universitário, Arapongas, Paraná, Brazil
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, PROCAPE, University of Pernambuco, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Pernambuco, Brazil
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Leonardo Roever
- Department of Cardiovascular Surgery, Federal University of Uberlândia, Uberlândia, MG, Brasil
| | | | | | - Felipe Borsu de Salles
- Department of Cardiovascular Surgery, Institute of Cardiology - Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Giovana Munhoz Khalil
- Department of Cardiovascular Surgery, Hospital Norte Paranaense, Jardim Universitário, Arapongas, Paraná, Brazil
| | - Pedro Felipe Gomes Nicz
- Department of Cardiology and Cardiovascular Surgery, Heart Institute - INCOR-HCFM-USP, São Paulo, SP, Brazil
| | - Omar Asdrúbal Vilca Mejía
- Department of Cardiology and Cardiovascular Surgery, Heart Institute - INCOR-HCFM-USP, São Paulo, SP, Brazil
| | - Arnaldo Akio Okino
- Department of Cardiovascular Surgery, Hospital Norte Paranaense, Jardim Universitário, Arapongas, Paraná, Brazil
| | - Ricardo de Carvalho Lima
- Department of Cardiovascular Surgery, PROCAPE, University of Pernambuco, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Pernambuco, Brazil
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