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1.
BMC Cardiovasc Disord ; 21(1): 592, 2021 12 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1566507

RESUMEN

BACKGROUND: COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. CASE PRESENTATION: A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. CONCLUSIONS: This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.


Asunto(s)
COVID-19 , Procedimiento de Fontan , Gangrena , Trombolisis Mecánica , Complicaciones Posoperatorias , Tromboflebitis , Atresia Tricúspide , Warfarina/uso terapéutico , Amputación Quirúrgica/métodos , Aleteo Atrial/tratamiento farmacológico , Aleteo Atrial/etiología , COVID-19/sangre , COVID-19/complicaciones , COVID-19/terapia , Procedimiento de Fontan/efectos adversos , Procedimiento de Fontan/métodos , Gangrena/etiología , Gangrena/cirugía , Cardiopatías Congénitas/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Extremidad Inferior/cirugía , Masculino , Trombolisis Mecánica/efectos adversos , Trombolisis Mecánica/métodos , Persona de Mediana Edad , Flebografía/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Síndrome del Seno Enfermo/diagnóstico , Síndrome del Seno Enfermo/etiología , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , Tromboflebitis/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Atresia Tricúspide/etiología , Atresia Tricúspide/cirugía
3.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artículo en Inglés | MEDLINE | ID: covidwho-999234

RESUMEN

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.


Asunto(s)
Tratamiento Farmacológico de COVID-19 , COVID-19 , Drenaje , Mediastinitis , Manejo de Atención al Paciente/métodos , Complicaciones Posoperatorias , Absceso Retrofaríngeo , Procedimientos Quirúrgicos Torácicos/métodos , COVID-19/epidemiología , COVID-19/terapia , Enfermedad Catastrófica/terapia , Diagnóstico Diferencial , Drenaje/efectos adversos , Drenaje/métodos , Humanos , Control de Infecciones/métodos , Masculino , Mediastinitis/diagnóstico , Mediastinitis/etiología , Mediastinitis/fisiopatología , Mediastinitis/cirugía , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Cuello/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Absceso Retrofaríngeo/diagnóstico , Absceso Retrofaríngeo/fisiopatología , Absceso Retrofaríngeo/cirugía , SARS-CoV-2 , Resultado del Tratamiento
4.
Laryngoscope ; 131(6): E1918-E1925, 2021 06.
Artículo en Inglés | MEDLINE | ID: covidwho-986314

RESUMEN

OBJECTIVE: The COVID-19 pandemic has led to unprecedented demands on healthcare with many requiring intubation. Tracheostomy insertion has often been delayed and the enduring effects of this on voice, swallow, and airway outcomes in COVID-19 tracheostomy patients are unknown. The aim of this study was to prospectively assess these outcomes in this patient cohort following hospital discharge. METHODS: All COVID-19 patients who had undergone tracheostomy insertion, and were subsequently decannulated, were identified at our institution and followed up 2 months post-discharge. Patient-reported (PROMS) and clinician-reported outcome measures, endoscopic examination, and spirometry were used to assess voice, swallow, and airway outcomes. RESULTS: Forty-one patients were included in the study with a mean age of 56 years and male:female ratio of 28:13. Average duration of endotracheal intubation was 24 days and 63.4% of tracheostomies were performed at day 21 to 35 of intubation. 53.7% had an abnormal GRBAS score and 30% reported abnormal swallow on EAT-10 questionnaire. 81.1% had normal endoscopic examination of the larynx, however, positive endoscopic findings correlated with the patient self-reported VHI-10 (P = .036) and EAT-10 scores (P = .027). 22.5% had spirometric evidence of fixed upper airway obstruction using the Expiratory-Disproportion Index (EDI) and Spearman correlation analysis showed a positive trend between abnormal endoscopic findings and EDI scores over 50 (P < .0001). CONCLUSION: The preliminary results of this study reveal a high incidence of laryngeal injury among patients who underwent intubation and tracheostomy insertion during the COVID-19 pandemic. As these patients continue to be followed up, the evolution of these complications will be studied. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1918-E1925, 2021.


Asunto(s)
COVID-19/cirugía , Deglución/fisiología , Complicaciones Posoperatorias/fisiopatología , Ventilación Pulmonar/fisiología , Traqueostomía , Calidad de la Voz/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , COVID-19/fisiopatología , Correlación de Datos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Intubación Intratraqueal , Laringe/lesiones , Laringe/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Espirometría , Resultado del Tratamiento , Adulto Joven
5.
J Plast Reconstr Aesthet Surg ; 74(3): 644-710, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-912072

RESUMEN

Globally, there has been a measured response to rationalise elective operating during the Coronavirus disease 2019 (COVID-19) pandemic. In terms of breast cancer care, this has led to a restricted provision of reconstruction with autologous free tissue transfer. A primary concern is the risk of mortality in elective surgery patients who develop COVID-19. The aim of this report is to describe the observed physiological impact of the virus on our patient, and to address how outpatient care after autologous free tissue transfer can be delivered to COVID-19 positive patients. In March 2020, we performed a bilateral breast reconstruction with a deep inferior epigastric perforator flap and a superficial inferior epigastric perforator flap. The patient became symptomatic on day three post-operatively, tested positive for COVID-19 and was discharged home. Drain and dressing management was continued through the use of telemedicine. Two weeks following the operation, a breast seroma formed that was drained semi-electively in the COVID-19 positive area of the Emergency Department. The patient visited the dressing clinic twice in total and healed after three weeks. Despite undergoing complex surgery and having pre-operative chemotherapy, our patient suffered a mild form of the virus limited to upper respiratory symptoms. Physiologically we did not see any significant difference to that of the normal post-operative course. This case demonstrates the possibility of managing autologous breast reconstruction patients using telemedicine. Although COVID-19 can complicate, or even be fatal, in the perioperative course, our patient thankfully suffered no discernable negative outcome from her infection.


Asunto(s)
Cuidados Posteriores , Neoplasias de la Mama , COVID-19 , Recurrencia Local de Neoplasia , Aislamiento de Pacientes , Complicaciones Posoperatorias , Cuidados Posteriores/métodos , Cuidados Posteriores/tendencias , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , COVID-19/diagnóstico , COVID-19/fisiopatología , COVID-19/terapia , Femenino , Colgajos Tisulares Libres , Humanos , Mamoplastia/efectos adversos , Mamoplastia/métodos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/cirugía , Alta del Paciente/tendencias , Aislamiento de Pacientes/métodos , Aislamiento de Pacientes/organización & administración , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Resultado del Tratamiento , Cicatrización de Heridas
7.
Bone Joint J ; 102-B(9): 1256-1260, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-844475

RESUMEN

AIMS: The risk to patients and healthcare workers of resuming elective orthopaedic surgery following the peak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult to quantify. This has prompted governing bodies to adopt a cautious approach that may be impractical and financially unsustainable. The lack of evidence has made it impossible for surgeons to give patients an informed perspective of the consequences of elective surgery in the presence of SARS-CoV-2. This study aims to determine, for the UK population, the probability of a patient being admitted with an undetected SARS-CoV-2 infection and their resulting risk of death; taking into consideration the current disease prevalence, reverse transcription-polymerase chain reaction (RT-PCR) testing, and preassessment pathway. METHODS: The probability of SARS-CoV-2 infection with a false negative test was calculated using a lower-end RT-PCR sensitivity of 71%, specificity of 95%, and the UK disease prevalence of 0.24% reported in May 2020. Subsequently, a case fatality rate of 20.5% was applied as a worst-case scenario. RESULTS: The probability of SARS-CoV-2 infection with a false negative preoperative test was 0.07% (around 1 in 1,400). The risk of a patient with an undetected infection being admitted for surgery and subsequently dying from the coronavirus disease 2019 (COVID-19) is estimated at approximately 1 in 7,000. However, if an estimate of the current global infection fatality rate (1.04%) is applied, the risk of death would be around 1 in 140,000, at most. This calculation does not take into account the risk of nosocomial infection. Conversely, it does not factor in that patients will also be clinically assessed and asked to self-isolate prior to surgery. CONCLUSION: Our estimation suggests that the risk of patients being inadvertently admitted with an undetected SARS-CoV-2 infection for elective orthopaedic surgery is relatively low. Accordingly, the risk of death following elective orthopaedic surgery is low, even when applying the worst-case fatality rate. Cite this article: Bone Joint J 2020;102-B(9):1256-1260.


Asunto(s)
Enfermedades Asintomáticas , Causas de Muerte , Infecciones por Coronavirus/epidemiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Complicaciones Posoperatorias/mortalidad , Teorema de Bayes , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Procedimientos Quirúrgicos Electivos/mortalidad , Reacciones Falso Negativas , Femenino , Humanos , Incidencia , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Posoperatorias/fisiopatología , Medición de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , Reino Unido
8.
Bone Joint J ; 102-B(9): 1136-1145, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-829492

RESUMEN

AIMS: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. METHODS: This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. RESULTS: COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. CONCLUSION: Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136-1145.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Infecciones por Coronavirus/epidemiología , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Neumonía Viral/epidemiología , Complicaciones Posoperatorias/mortalidad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Artroplastia de Reemplazo de Cadera/métodos , COVID-19 , Causas de Muerte , Estudios de Cohortes , Femenino , Fracturas de Cadera/epidemiología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pandemias , Atención Perioperativa/métodos , Complicaciones Posoperatorias/fisiopatología , Valores de Referencia , Medición de Riesgo , Reino Unido
9.
Ann Surg ; 272(4): e275-e279, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-767004

RESUMEN

OBJECTIVE: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. BACKGROUND: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously "conventional" hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures. METHODS: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS. RESULTS: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset. CONCLUSIONS: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Pandemias/prevención & control , Neumonía Viral/prevención & control , Anciano , COVID-19 , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Urgencias Médicas , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Control de Infecciones/métodos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Italia , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Neumonía Viral/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Medición de Riesgo
10.
Pan Afr Med J ; 36: 170, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-743012

RESUMEN

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Lesiones Cardíacas/fisiopatología , Neumonía Viral/complicaciones , Complicaciones Posoperatorias/fisiopatología , Cálculos Ureterales/cirugía , Enfermedades Asintomáticas , COVID-19 , Infecciones por Coronavirus/diagnóstico , Resultado Fatal , Lesiones Cardíacas/etiología , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Factores de Riesgo
11.
J Atheroscler Thromb ; 28(1): 90-95, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: covidwho-736814

RESUMEN

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly via the respiratory route. Elderly patients or those with underlying diseases are more seriously affected. We report a case of COVID-19 infection in a geriatric patient with arteriovenous thrombosis of the right lower limb. Despite persistent anticoagulant therapy, the patient's arterial thrombosis continued to progress and presented with ischemic necrosis of the lower extremity. After amputation in this case, the levels of D-dimer and inflammatory cytokine increased progressively, and he presented with acute myocardial infarction, which progressed rapidly to multisystem organ failure. However, whether coronavirus can directly cause the damage of the cardiovascular system and thrombosis needs further investigation.


Asunto(s)
Amputación Quirúrgica , COVID-19 , Extremidad Inferior , Insuficiencia Multiorgánica , Infarto del Miocardio , Complicaciones Posoperatorias , SARS-CoV-2/aislamiento & purificación , Trombosis , Anciano , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/métodos , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , COVID-19/terapia , Resultado Fatal , Arteria Femoral/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Humanos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Extremidad Inferior/cirugía , Masculino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/terapia , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Necrosis/etiología , Necrosis/cirugía , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Trombosis/complicaciones , Trombosis/etiología , Trombosis/fisiopatología , Trombosis/terapia , Ultrasonografía/métodos
12.
J Card Surg ; 35(10): 2479-2485, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-712959

RESUMEN

BACKGROUND: Both coronavirus disease (COVID-19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID-19 who underwent cardiac surgery. METHODS: In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID-19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. RESULTS: The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2 , respectively. Four patients underwent off-pump cardiac surgery and 21 underwent on-pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50-147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity-matched group of patients who underwent cardiac surgery in the pre-COVID era. The median intubation time was 13 hours (IQR, 9.5-18), which was comparable to that of pre-COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2 , and mortality rate were higher and the PaO2 /FiO2 ratio was lower than those of the nonreadmitted patients. CONCLUSIONS: Although early respiratory outcomes of asymptomatic COVID-19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity-scored matched non-COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.


Asunto(s)
Betacoronavirus , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Infecciones por Coronavirus/epidemiología , Cardiopatías/cirugía , Neumonía Viral/epidemiología , Complicaciones Posoperatorias/fisiopatología , Volumen de Ventilación Pulmonar/fisiología , COVID-19 , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Femenino , Cardiopatías/epidemiología , Mortalidad Hospitalaria , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Pruebas de Función Respiratoria , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2 , Tasa de Supervivencia/tendencias
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