Thoracic surgery during COVID-19 pandemic
Advanced Thoracic Surgery, Akademisyen Kitabevi, ss.67-72, 2021
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2021
- Yayınevi: Akademisyen Kitabevi
- Sayfa Sayıları: ss.67-72
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
The COVID-19 pandemic is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and continues to have a growing impact worldwide, leading to significant changes in human relationships, social life, and medical practices. These changes also affect thoracic surgery practices and prompt hospital administrators and healthcare workers to take certain precautions. The rapid adaptation of healthcare facilities to pandemic conditions plays a crucial role in minimizing the destructive effects of the pandemic.SARS-CoV-2, a single-stranded RNA virus, was first detected in respiratory samples on January 7, 2020. It causes symptoms such as fever, cough, shortness of breath, fatigue, loss of taste and smell, conjunctivitis, back and joint pain, headache, and diarrhea. Poor prognosis factors include elevated D-dimer levels, lymphopenia, and computed tomography (CT) findings. It has also been shown that CRP levels are higher in patients requiring intensive care.Even asymptomatic patients can present with pneumonic infiltrations on CT scans. It has been demonstrated that in some patients, CT findings can progress from focal infiltrations to bilateral diffuse ground-glass opacities within 1 to 3 weeks. In patients with underlying diseases such as chronic obstructive pulmonary disease, interstitial lung disease, or lung cancer, infiltrations associated with Covid-19 may go unnoticed.With the Covid-19 outbreak, the routine functioning of healthcare facilities has changed, various precautions have been taken, and this unpredictable disease has brought the rational use of medical resources into question. In the early days of the pandemic, issues such as the allocation of personal protective equipment for healthcare workers, the need for ward and intensive care beds, and ventilators were among the topics that needed to be addressed. As of today, due to the unpredictable total duration of the pandemic and its effects on the healthcare system, the treatment of some diseases with high mortality rates needs to continue. The timing of treatment is directly related to the prognosis in patients with malignancies. Surgical delays of 4, 8, and 16 weeks in early-stage lung cancer patients result in stage progression rates of 3%, 13%, and 21%, respectively, and progression rates of 13%, 31%, and 46%.During the pandemic, the surgical evaluation of patients, preoperative studies, and rules and methods of surgical preparation vary in many centers. These measures primarily depend on the duration of the pandemic, the availability of hospital facilities for surgery, and the number of Covid-19 (+) patients. At this point, patient selection can be done according to the recommendations of the \"Thoracic Surgery Outcomes Research Network\". Firstly, in hospitals where there are few Covid-19 patients, if hospital resources are suitable for surgery and the course of Covid-19 is not rapidly increasing, thoracic surgery can be performed. Secondly, in hospitals where there are many Covid-19 patients, if hospital resources are limited and the course of Covid-19 is rapidly increasing, all planned operations except cancer surgery should be postponed. Thirdly, in cases where almost all hospital resources are directed towards Covid-19, surgery should only be performed on patients with tumor-related sepsis, severe airway obstruction, and hemodynamic instability. Non-emergency surgical interventions should be postponed and followed up or referred to another hospital where surgery can be performed.Since Covid-19 particularly affects the lungs, the mortality of Covid-19 (+) patients is very high, especially after thoracic surgery operations. Additionally, the surgical intervention itself reduces lung function and exposes the surgical team to aerosolized viral load. To minimize postoperative mortality and avoid viral exposure, the thoracic surgery team must ensure that the patient is not Covid-19 (+). Therefore, a detailed history should be taken and clinical, biochemical, and radiological tests should be completed before the operation.After hospitalization.