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2.
Thorac Cardiovasc Surg ; 69(3): 252-258, 2021 04.
Article in English | MEDLINE | ID: covidwho-939460

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus primarily affecting the respiratory system, was initially diagnosed in Wuhan, China, in late 2019. Identified as coronavirus disease 2019 (COVID-19) by the World Health Organization, the virus rapidly became a global pandemic. The effects on health care worldwide were unprecedented as countries adapted services to treat masses of critically ill patients.The aim of this study is to analyze the effect that the COVID-19 pandemic had on thoracic surgery at a major trauma center during peak prevalence. METHODS: Prospective unit data were collected for all patients who underwent thoracic surgery during March 2020 until May 2020 inclusive. Retrospective data were collected from an earlier comparable time period as a comparison. RESULTS: In the aforementioned time frame, 117 thoracic surgical operations were performed under the care of four thoracic surgeons. Six operations were performed on three patients who were being treated for SARS-CoV-2. One operation was performed on a patient who had recovered from SARS-CoV-2. There were no deaths due to SARS-CoV-2 in any patient undergoing thoracic surgery. CONCLUSION: This study demonstrates that during the first surge of SARS-CoV-2, it was possible to adapt a thoracic oncology and trauma service without increase in mortality due to COVID-19. This was only possible due to a significant reduction in trauma referrals, cessation of benign and elective work, and the more stringent reprioritization of cancer surgery. This information is vital to learn from our experience and prepare for the predicted second surge and any similar future pandemics we might face.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , Health Priorities/organization & administration , Thoracic Surgical Procedures , Trauma Centers , Adult , Aged , Appointments and Schedules , COVID-19/diagnosis , COVID-19/epidemiology , Clinical Decision-Making , Elective Surgical Procedures , Emergencies , Female , Humans , London/epidemiology , Male , Middle Aged , Prevalence , Prospective Studies , Referral and Consultation/organization & administration , Retrospective Studies , Risk Assessment , Risk Factors , Thoracic Surgical Procedures/adverse effects
4.
J Thorac Cardiovasc Surg ; 160(2): 585-592.e2, 2020 08.
Article in English | MEDLINE | ID: covidwho-46386

ABSTRACT

OBJECTIVES: To illustrate the clinical course and difficulties in early diagnosis of coronavirus disease 2019 (COVID-19) in patients after thoracic surgery. METHODS: We retrospectively analyzed the clinical course of the first 11 patients diagnosed with COVID-19 after thoracic surgery in early January 2020. Postoperative clinical, laboratory, and radiologic records and the time line of clinical course were summarized. Potential prognostic factors were evaluated. RESULTS: In the 11 confirmed cases (3 female, 8 male), median days from symptom onset to case detection was 8. Insidious symptom onset and misinterpreted postoperative changes on chest computed tomography (CT) resulted in delay in diagnosis. There were 3 fatalities due to respiratory failure, whereas 4 severe and 4 mild cases recovered and were discharged. All patients had once experienced leukocytosis and eosinopenia. Remittent fever and resected lung segments ≥5 were associated with fatality. CONCLUSIONS: The case fatality rate of postsurgical patients subsequently diagnosed with COVID-19 was 27.3%. Insidious symptom onset, postoperative leukocytosis with lymphopenia, and postsurgical CT changes overshadowed the early signs of viral pneumonia. Dynamic symptom monitoring, serial chest CTs, and tests for viral RNA and serum antibody improve the chance for prompt detection of COVID-19. Consideration should be given to preadmission and preoperative screening and strict contact isolation during the postoperative period.


Subject(s)
Betacoronavirus/pathogenicity , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Esophageal Neoplasms/surgery , Lung Neoplasms/surgery , Pneumonia, Viral/diagnosis , Thoracic Surgical Procedures/adverse effects , Aged , COVID-19 , COVID-19 Testing , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Coronavirus Infections/virology , Delayed Diagnosis , Diagnostic Errors , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/mortality , Female , Host Microbial Interactions , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/mortality , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Thoracic Surgical Procedures/mortality , Time Factors , Treatment Outcome
5.
J Thorac Cardiovasc Surg ; 160(2): 601-605, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-46092

ABSTRACT

The extraordinary demands of managing the COVID-19 pandemic has disrupted the world's ability to care for patients with thoracic malignancies. As a hospital's COVID-19 population increases and hospital resources are depleted, the ability to provide surgical care is progressively restricted, forcing surgeons to prioritize among their cancer populations. Representatives from multiple cancer, surgical, and research organizations have come together to provide a guide for triaging patients with thoracic malignancies as the impact of COVID-19 evolves as each hospital.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Delivery of Health Care, Integrated/organization & administration , Pneumonia, Viral/therapy , Thoracic Neoplasms/surgery , Thoracic Surgical Procedures , Triage/organization & administration , COVID-19 , Clinical Decision-Making , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Health Services Needs and Demand/organization & administration , Host Microbial Interactions , Humans , Needs Assessment/organization & administration , Occupational Health , Pandemics , Patient Safety , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Thoracic Neoplasms/epidemiology , Thoracic Surgical Procedures/adverse effects , Time-to-Treatment
6.
Curr Med Sci ; 40(2): 295-300, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-19574

ABSTRACT

The outbreak of corona virus disease 2019 (Covid-19) imposes a major challenge in managing patients undergoing surgical operation. In this study, we analyzed clinical and transmission features of 25 cases of Covid-19 from a single thoracic department, including 13 patients and 12 health care staff. There were 13 males and 12 females. The median age of the patients was 61 (range: 51 to 69) years. The median age of the health care staff was 35 (range: 22 to 51) years. By the end of follow-up date (Mar. 3, 2020), there were 16 non-severe cases (64%) and 9 severe cases (36%), 5 cases were dead (20%). Nineteen (76%) of the infected cases were confirmed by SARS-CoV-2 nucleic acid test, the rest were clinically diagnosed as suspected Covid-19 cases, and 19 (76%) of the infected cases had positive exposure history. We found that COPD was significantly associated with severity and death (P=0.040, and P=0.038, respectively), and chest operation was significantly associated with death for Covid-19 patients (P=0.039). A potential "super spreader" may be the source of the transmission before the implementation of quarantine and comprehensive protection. It was concluded that Covid-19 is associated with poor prognosis for patients undergoing thoracic operation, especially for those with COPD. Implementation of comprehensive protective measures is important to control nosocomial infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Thoracic Surgical Procedures/adverse effects , Aged , COVID-19 , Coronavirus Infections/diagnostic imaging , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Postoperative Complications , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
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