ABSTRACT
BACKGROUND: Coronavirus disease 2019 increased the numbers of patients requiring prolonged mechanical ventilation, with a subsequent increase in tracheostomy procedures. Coronavirus disease 2019 patients are high risk for surgical complications. This review examines open surgical and percutaneous tracheostomy complications in coronavirus disease 2019 patients. METHODS: Medline and Embase databases were searched (November 2021), and the abstracts of relevant articles were screened. Data were collected regarding tracheostomy technique and complications. Complication rates were compared between percutaneous and open surgical tracheostomy. RESULTS: Percutaneous tracheostomy was higher risk for bleeding, pneumothorax and false passage. Surgical tracheostomy was higher risk for peri-operative hypoxia. The most common complication for both techniques was post-operative bleeding. CONCLUSION: Coronavirus disease 2019 patients undergoing tracheostomy are at higher risk of bleeding and peri-operative hypoxia than non-coronavirus disease patients. High doses of anti-coagulants may partially explain this. Reasons for higher bleeding risk in percutaneous over open surgical technique remain unclear. Further research is required to determine the causes of differences found and to establish mitigating strategies.
ABSTRACT
Introduction: The purpose of this study is to establish the infectivity of COVID-19 patients at the time of surgical tracheotomy. Method: This is a prospective single-institution study across 3 hospital sites during the United Kingdom's first wave of the COVID-19 pandemic in 2020. Intubated and ventilated patients for respiratory wean tracheotomy underwent SARS-Cov-2 polymerase chain reaction (PCR) nasal, throat, and endotracheal tube swabs at the time of planned surgical procedure. These were assessed via quantitative real-time reverse-transcription PCR. The tracheal tissue windows excised during the tracheotomy were cultured for SARS-Cov-2 using Vero E6 and co2 cells. Serum taken at the time of procedure was also assessed for antibody titers against SARS-Cov-2, via neutralization assays. Results: A total of 37 patients were included in the study. PCR swab testing yielded 9 positive results. None of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patient who had sera sampling demonstrated neutralization antibodies at a minimum titer of 1:80. There was no correlation between sample CT values nor sample quantities with the number of days since the onset of symptoms (P > .05). Conclusion: Our results did not demonstrate COVID- 19 infectivity at the time of tracheotomy. The authors agree that the data do not undermine national and international guidance on tracheotomy after day 10 of mechanical ventilation and using FFF3/N95 masks. However, given the length of time to procedure in our data, infectivity at 10 days cannot be ruled out. We do, however, advise that a preoperative negative PCR swab is not necessary. We also recognize that antibody titer levels may serve as a useful adjunct for assessment of infectivity in these patients.
ABSTRACT
BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.