Clinical course of coronavirus disease 2019 in 11 patients after thoracic surgery and challenges in diagnosis

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. Post-operative clinical, laboratory, radiological records and timeline of clinical course were summarized. Potential prognostic factors were evaluated. Result In the 11 confirmed cases (3 females, 8 males), median days from symptom onset to case detection was 8. Insidious symptom onset and misinterpreted post-operative changes on chest computed tomography (CT) resulted in delay in diagnosis. There were 3 fatalities due to respiratory failure, while 4 severe and 4 mild cases recovered and were discharged. All patients had once leukocytosis and eosinopenia. Remittent fever and resected lung segments ≥ 5 were associated with fatality. Conclusions The case-fatality rate of post-surgical patients subsequently diagnosed with COVID-19 was 27.3%. Insidious symptom onset, post-operative leukocytosis with lymphopenia and post-surgical 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 pre-admission and pre-operative screening and strict contact isolation during the post-operative period.