Author's reply – Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection

Abstract

We thank Minervini et al. and Shakiba et al. for their letters in response to our recent study [[1]Lei et al.Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection.EClinicalMedicine. 2020; https://doi.org/10.1016/j.eclinm.2020.100331Summary Full Text Full Text PDF Scopus (747) Google Scholar]. We concur with Minervini and colleagues that comparison with comorbidity and age-matched, COVID-19 negative controls should have strengthened the scientific merit of the research. However, during the period of the research the participating hospitals performed approximately 15,000 elective surgeries. Due to the lack of recognition of the disease at a very early stage of the pandemic, some patients with potential infection were unintentionally scheduled for elective surgeries. And, it is not that suitable for us to retrospectively pick up (difficult to be randomly) some COVID-19 negative controls. So, our initial goal was to report the clinical characteristics and outcomes of the patients. Nevertheless, our conclusion that surgery during incubation period of COVID-19 increases mortality should be generalizable. This can be strengthened by Shakiba and Irani's mention that the mortality rate for surgical patients with ASA-II was between 0.3–1.4%, and 1.8–4.5% for ASA-III [[2]Daabiss M. American society of anaesthesiologists physical status classification.Indian J Anaesth. 2011; 55: 111-115Crossref PubMed Scopus (423) Google Scholar]. In our study, the majority of the patients’ condition was ASA I–II, with two patients in ASA-III. However, these two patients survived surgery. In addition, of the 34 patients, 30 underwent general anesthesia with endotracheal intubation and 4 underwent epidural anesthesia. We appreciate the chance to add this information. Our analysis showed that it was primarily the complexity and duration of surgeries (i.e. the degree of surgical trauma) but not (or less) the type of anesthesia nor ASA class that played a major role in activating/exacerbating the latent COVID-19 infection. The mortality of non-surgical patients with COVID-19 in Wuhan at that time was between 4.3% and 15% as reported [[3]Jiang F. Deng L. Zhang L. Cai Y. Cheung C.W. Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19).J Gen Intern Med. 2020; https://doi.org/10.1007/s11606-020-05762-wCrossref PubMed Scopus (759) Google Scholar]. None. Letter to the Editor: “Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection”Dear Editor, we read with great interest the publication entitled “Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection” [1]. Authors retrospectively analyzed data from 34 patients undergoing elective surgeries during the incubation period of COVID-19, reporting that nearly 45% of patients needed Intensive Care Unit (ICU) after surgery, while mortality rate was 20.5%. Notably, both admission to ICU and mortality rates were significantly higher as compared to previous reports [2]. Full-Text PDF Open AccessClinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infectionIn this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%. Full-Text PDF Open Access