Postoperative Evolution of Asymptomatic Covid-19 Patients Not Recognized Preoperatively: A Case Report of 12 Patients

Abstract

Background: In order to ensure better management of patients with coronavirus disease 2019 and to reduce disease transmission, all scheduled surgeries were postponed. However, with the flattening of the epidemiological curve, surgical activity was gradually resumed which was responsible for increasing the rate of postoperative complications and mortality for undiagnosed asymptomatic patients operated on during the incubation period. The aim of our study was to evaluate the postoperative evolution of asymptomatic undiagnosed patients who developed COVID-19 after scheduled surgery. Materials and Methods: This is a retrospective monocentric observational study of 12 initially asymptomatic patients who were operated on during their COVID-19 incubation period in the operating theatres of Mohamed V military training hospital of rabat during the period from April 1 to September 30, 2020. Results: 4638 patients were operated on. Only 12 patients developed COVID-19 infection after confirmation by a reverse transcriptase Polymerase Chain Reaction test postoperatively. The most common symptom was fever (91.6%). The postoperative course was marked by the development of several complications such as secondary superinfection (66.6%), acute respiratory distress syndrome (58.3%), and shock (50%). Seven of the 12 (58.3%) patients were admitted to intensive care and 5/12 (41.6%) required invasive ventilation and subsequently died. Acute respiratory distress syndrome was the main complication in all patients who died. Conclusion: Many challenges are encountered when performing surgical activity during the pandemic period. Nevertheless, knowledge of the patient’s COVID-19 status prior to any surgical procedure should be considered in order to reduce and control the risk of postoperative morbidity and mortality.