Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

Use of the derived isohemagglutinin parameter to predict patients with COVID-19 in need of an intensive care unit.

Predicting which patients will need the intensive care unit (ICU) due to severe COVID-19 is critical in terms of disease treatment. In this study, the use of the derived isohemagglutinin (dIH) parameter calculated from isohemagglutinin (IH) values and neutrophil to lymphocyte ratios for prediction of clinical care (CLC), ICU admission and mortality status was investigated for the morbidity and mortality of COVID-19. The data of approximately 21,500 patients admitted to the hospital with the suspicion of COVID-19 were scanned retrospectively. A total of 352 patients with IH results were divided into three groups according to CLC, ICU admission and mortality. Isohemagglutinin, hemogram and biochemistry test results, demographic characteristics, chronic diseases, length of stay, treatments, ICU admission and mortality records were reviewed for all patients. The relationship between test results, demographic characteristics, clinical status and mortality was investigated using statistical methods. The dIH values of patients with ICU admission and mortality were much lower than those of CLC patients [median (min-max): 3.34 (0.14-95.8) and 0.82 (0.05-42.3) vs. 0.18 (0.01-20.6) titers, p < 0.01, respectively]. In the ROC analysis for the power of dIH to discriminate ICU admission, the cutoff was ≤ 0.68 with sensitivity 88.9%, and specificity 79.6%. It was determined that a 1-unit increase in dIH values decreased the need for ICU by 2.09 times and the mortality of those receiving ICU treatment by 2.02 times. dIH values calculated in the early stages of the disease in patients with COVID-19 can be used to estimate the clinical progression associated with ICU admission and mortality.

Results of Coupled Plasma Filtration Adsorption (CPFA) Treatment Applied to Critical COVID-19 Patients in Intensive Care Unit

In our study, we aimed to assess the efficacy of Coupled Plasma Filtration Adsorption (CPFA) treatment in situations with severe disease progression like sepsis, septic shock and multiple organ failure, considered to be secondary to cytokine storm, in COVID-19 disease. Treatments used in situations with development of CS include methods like passive antibody treatment called convalescent plasma use, anti-IL-6 monoclonal antibody use (tocilizumab, siltuximab), use of antibodies produced against interferon (IFN) subtypes (sifalimumab), continuous renal replacement treatment (CRRT) and coupled plasma filtration adsorption (CPFA). Clinical and laboratory findings such as desaturation, increase in respiratory rate, refractory high fever (>390C), liver enzyme elevations such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), International normalized ratio (INR) and Bilirubin, C-reactive protein (CRP)-Procalcitonin elevation, increased lymphopenia, increased Ferritin and D-dimer, severe deterioration in arterial blood gas (Horovitz value <200), deterioration in microcirculation, increased need for inotropic agents, low SOFA scores (Sequential Organ Failure Assessment> 6%), sepsis, septic shock in these patients were evaluated. Immediately before beginning CPFA treatment, in the 24th and 48th hour afterward and on the 7th day measured and/or calculated SOFA values, Horowitz index values (PaO2/FiO2 ratio, partial pressure of oxygen in blood / the fraction of oxygen in the inhaled air), presence of fever, noradrenaline requirements for hypotension, SpO2, heart rate and a range of related laboratory values (IL-6, lymphocyte count, CRP, procalcitonin, AST, ALT, d-dimer, Hb, total and indirect bilirubin) were obtained from files and system data.

The Experience of Our Cardiovascular Surgery Intensive Care in Preoperative False-Negative and Asymptomatic Patients with SARS-COV-2 Infection

Objective: There is little data in the literature on the effects of COVID-19 in patients undergoing cardiac surgery. Our aim in this study is to describe the post-cardiac surgical effects of COVID-19, the basic characteristics of the patients and their laboratory findings;and also to discuss the mechanism underlying the poor diagnostic performance of rRT-PCR. Methods: The data of 191 patients who were operated between 18 May 2020- 07 June 2021 were retrospectively analyzed. A total of 12 patients who were asymptomatic and rRT-PCR (-) preoperatively and rRT-PCR positive postoperatively were included. Patients who required emergency operation, did not perform rRT-PCR in the preoperative period or had rRT-PCR (+), had outpatient surgery were not included. The patients’ age, operation, length of stay in the ICU, intubation times, echocardiography, blood gas and biochemistry results and PCR results were recorded. Results: In the study, postoperative rRT-PCR was studied from 87 patients and the result was (+) in 12 (13.8%) patients. Two of 12 (16.7%) patients died due to SARS-CoV-2 pneumonia. While the mean values of preoperative leukocytes (7.78 103/mcL), lymphocytes (1.52 103/mcL) and CRP (49.27mg/dL) were within the normal range, the mean values of ferritin (823 ng/ml) and D-Dimer (1138 ng/ml) were above the normal range. Conclusion: We recommend that patients has to be isolated for at least 7 days before the operation. Also sputum samples from the tracheal tube should be studied simultaneously nasopharyngeal PCR samples in the preoperative and the early postoperative period in order to minimize false negative PCR results. (English) [ FROM AUTHOR] Amaç: Kalp cerrahisi geçiren hastalarda COVID-19’un etkileri hakkında literatürde çok az veri mevcuttur. Bu çalışmada amacımız, COVID-19’un kardiyak cerrahi sonrası etkilerini, hastaların temel özelliklerini ve laboratuvar bulgularını tanımlamaktır. Aynı zamanda preoperatif süreçte rRT-PCR’nin zayıf tanı performansının altında yatan mekanizmayı tartışmaktır. Yöntem: Erişkin kalp cerrahisi kliniğimizde 18 Mayıs 2020 - 07 Haziran 2021 tarihleri arasında ameliyat edilen 191 hastanın verileri geriye dönük olarak incelendi. Ameliyat öncesi asemptomatik ve rRT-PCR (-) olan ve ameliyat sonrası rRT-PCR pozitifleşen toplam 12 hasta çalışmaya dahil edildi. Acil operasyon gerektiren, preoperatif dönemde rRT-PCR çalışmamış veya rRT-PCR (+) olan, günübirlik cerrahi operasyon geçirenler ile entübe edilmeden opere edilen hastalar çalışmaya dahil edilmedi. Hastaların yaş, cinsiyet, tanı, yapılan operasyon, YBÜ yatış süreleri, entübasyon süreleri, ekokardiyografi, kan gazı ve biyokimya sonuçları ile PCR sonuçları kaydedildi. Bulgular: Çalışmada 87 hastadan postoperatif rRT-PCR çalışıldı ve 12 (%13.8) hastada sonuç (+) geldi. 12 hastadan 2’si (%16.7) SARS-CoV-2 pnömonisi nedeniyle ex oldu. Preoperatif lökosit (7.78 103/mcL), lenfosit (1.52 103/mcL) ve CRP (49.27 mg/L) değerlerinin ortalaması normal değer aralığında iken, ferritin (823 ng/ ml) ve D-Dimer(1138 ng/ml) değerlerinin ortalaması normal değer aralığının üzerinde bulundu. Preoperatif ve postoperatif Pa02/Fi02 oranlarındaki değişkenlik ex olan hastalarda (ortalama: 40,50±4,94) sağkalan hastalarınkine (ortalama: 16,4±9,37) oranla daha yüksek bulundu (P= 0.053). Sonuç: Ekstrakorporeal dolaşımın kendisinin sistemik bir inflamatuar yanıta neden olarak COVID-19 tablosunu şiddetlendirebileceği unutulmamalıdır. Aynı zamanda daha az yalancı negatiflik PCR sonuçları görmek için, kardiyak cerrahiye girecek olan hastalara operasyon öncesi en az 7 gün izolasyon ve SARS-Cov-2 için PCR örneklerinin mümkün olduğunca alt solunum yollarından alınmasını önermekteyiz (Turkish) [ FROM AUTHOR] Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Assessment of severity and mortality of COVID-19 with anti-A1 and anti-B IgM isohaemagglutinins, a reflection of the innate immune status.

AIMS: The relationship between the innate immune system that creates the polysaccharide antibody response and COVID-19 is not fully understood. In this study, it was aimed to determine the predictive values of isohaemagglutinins in COVID-19 severity/mortality. METHODS: Approximately 15 440 patients diagnosed with COVID-19 were examined, and a total of 286 patients with anti-B and anti-A1 IgM isohaemagglutinins test results were randomly enrolled in the study. These patients were stratified into two groups according to anti-A1 (n: 138 blood type B or O) and anti-B (n: 148 blood type A) IgM isohaemagglutinins. Anti-A1 or/and anti-B IgM, biochemical parameters, symptoms, chronic diseases, hospitalisation status, intubation status, admission to intensive care unit (ICU) and exitus status were recorded and evaluated for all patients. RESULTS: Anti-A1 IgM and anti-B IgM were significantly lower in ICU patients (7.5 ± 9.9 vs 18.0 ± 20.4 and 5.5 ± 6.3 vs 19.3 ± 33.6 titres, respectively; P < .01) and in exitus patients (3.8 ± 3.6 vs 16.7 ± 18.7 and 3.5 ± 4.7 vs 16.9 ± 29.6 titres respectively; P < .01). In the ROC analysis performed to differentiate between exitus and discharge within groups, the sensitivity of anti-B IgM and anti-A1 IgM at cut-off ≤4 was 88.9% and 79.6%, specificity 66.0% and 73.4%, and AUC 0.831 and 0.861, respectively (P < .01). Anti-A1 IgM decreased the mortality risk 0.811 times per unit while anti-B IgM decreased 0.717 times (P < .01). CONCLUSION: Anti-B and anti-A1 isohaemagglutinins, which are an expression of the innate immune system, can be used to predict the severity and mortality of COVID-19 disease.

Abdominal wall blocks for emergency ileostomy operation in a patient with COVID-19 pneumonia: a case report.

The anesthesia method to be administered during emergency surgical procedures for COVID-19 (Coronavirus Disease 2019) pneumonia patients carries great importance for both patient and surgical team. Regional blocks are generally used to ensure postoperative analgesia after abdominal surgery with general anesthesia. In this case, involving a patient receiving anticoagulant treatment due to COVID-19 pneumonia with planned emergency operation, the aim was to present the anesthesia management with rectus sheath and transversus abdominis plane block combination for the ileostomy operation. Due to the administered blocks, the patient was not given general anesthesia. Hence, transmission was reduced by minimizing aerosol formation in terms of protecting health personnel and worsening of the patient's pneumonia was prevented. The case is discussed in terms of regional anesthesia techniques offering a good alternative in appropriate cases for both employee and patient safety in the present day, when the whole world is affected by the COVID-19 pandemic.

Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax.

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.