ABSTRACT
Objectives: This study aims at reporting the surgical outcomes of COVID Associated Pulmonary Mucormycosis (CAPM) with special emphasis on surgical mortality. This study also compares the surgical outcomes between Non-COVID Pulmonary Mucormycosis (NCPM) and CAPM. Methods: This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram over 18 months which includes 25 patients. An analysis of demography, perioperative variables including complications were carried out. Various parameters were analysed to assess the factors affecting mortality. Results: Out of 25 patients, male-female ratio was 16:9 (64%:36%), with a mean age of 54.8 years (range, 33-72 years). Diabetes was the most common predisposing factor in 17 patients (68%). A total of 8 patients (32%) were on supplemental oxygen (1-4 lit/min) at the time of surgery. Extent of surgery was non-anatomical wedge resection in 5 patients (20%), lobectomy/bi-lobectomy in 18 patients (72%) and pneumonectomy in 2 patients (8%). Commonest complication was prolonged air leak (> 7 days) in 5 patients (20%). There were 5 peri-operative deaths (20%), all due to persistent fungal sepsis. ECOG scale > 2 (P = <0.001) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, no difference in the postoperative complications (P = 1.00) and mortality (P = 1.00) was observed. Conclusion: Aggressive surgical resection with clear margins should be offered in CAPM whenever feasible. In appropriately selected patients, surgical resection is safe and efficacious. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to NCPM.
ABSTRACT
Introduction: Crores of people worldwide have been afflicted with Covid 19 since the pandemic started in 2019. Pleural Empyema in Covid 19 patients is a challenging problem and requires a multidisciplinary approach for adequate management. There are very few published studies in the literature that evaluated this issue. In this study, we aim to report the surgical outcomes of post covid pleural empyema and to analyse factors predicting mortality. Methods: This study is a retrospective analysis of prospectively maintained data of cases of post covid empyema operated between May 20 to November 2021. A total of 37 patients were included for analysis. The demographic characteristics along with intra and postoperative variables were recorded including post-operative complications. Mortality was the primary outcome measure. Results: A total of 37 patients aged 22-68 years underwent surgery for Pleural Empyema during the study period. All patients underwent VATS decortication. There were 32 males and 5 females. The mean operative time was 284 minutes with the mean intraoperative blood loss of 522 ml. Average chest tube removal time was 9.5 days with an average hospital stay of 8.2 days. No recurrence was noted in any of the patients. Postoperative mortality 8.1% and morbidity was observed in 13.51% of patients. Conclusion: Post covid pneumothorax can be safely and effectively managed in selected patient with failed conservative management. The timing of the surgical intervention, requirement of ventilatory support and high oxygen requirement (>5 lit) were found to factors that significantly affect the mortality.