Objective To investigate the clinical characteristics and risk factors for perioperative lung surgery patients with SARS‐CoV‐2 Omicron variant infection. Methods The clinical data of patients who underwent lung surgery at the Department of Thoracic Surgery, Renmin Hospital of Wuhan University from December 1, 2022 to January 9, 2023 were retrospectively analyzed. The patients were divided into an infection group and a non-infection group according to whether they were infected with SARS-CoV-2. And the clinical data of two groups were collected and compared. Multiple linear regression analysis was used to explore the risk factors affecting the time of hospitalization. Results A total of 70 patients were enrolled in this study, including 36 (51.4%) males and 34 (48.6%) females at a median age of 61.0 (49.0, 66.8) years. There were 28 patients in the infection group and 42 patients in the non-infection group. The proportion of preoperative abnormal coagulation function and the risk of postoperative pulmonary infection in perioperative patients infected with SARS-CoV-2 were higher than those in the non-infection group (P<0.05). Subgroup analysis found that patients with preoperative SARS-CoV-2 infection were more likely to have pulmonary infection after surgery, but did not prolong the time of hospitalization or increase the risk of severe disease rate. The patients with postoperative SARS-CoV-2 infection had worse clinical prognosis, including longer time of hospitalization (P=0.004), higher ICU admission rate (P=0.000), higher lung infection rate (P=0.003) and respiratory failure rate (P=0.000). Multiple linear regression analysis showed that gender and extent of surgery were independent risk factors for prolonged hospitalization time. Conclusion Preoperative infection with SARS-CoV-2 Omicron variant will increase the risk of pulmonary infection, but it will not affect the clinical prognosis. However, postoperative infection with SARS-CoV-2 Omicron variant will still prolong the time of hospitalization, increase the ICU rate, and the risk of pulmonary complications.
Objective To evaluate the perioperative safety of lung surgery for patients with COVID-19. Method We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital. Patients who performed lung surgery and without COVID-19 at the same time were selected as a control group. Perioperative data between the two groups were compared. Results A total of 103 patients were included with 44 males and 49 females at average age of 62.2±2.1 years. All surgeries were performed by single-utility video-assisted thoracoscopic surgery (VATS). Among patients who recovered from COVID-19, 53 (51.5%) performed lobectomy, 30 (29.1%) performed segmentectomy, and 20 (19.4%) performed wedge resection. The interval between diagnosis of infection and lung surgery was less than 1 month in 32 (31.1%) patients, and more than 1 month in 71 (68.9%) patients. The results of nucleic acid test for all patients before surgery were negative. 13 (12.6%) patients had positive COVID-19 antibody of IgM, and 100 (97.1%) patients had positive IgG. A total of 20 patients experienced perioperative complications (13 patients with pulmonary air leakage, 3 with chylothorax, 2 with atrial fibrillation, and 2 patients with severe pulmonary complications). There was one perioperative death. Compared the patients who recovered from COVID-19 with those without COVID-19, there was no statistical difference in perioperative data including surgical duration, postoperative drainage, duration of thoracic tube, and duration of postoperative stay (P>0.05). There was no significant difference in perioperative complications between the two groups (P>0.05). Multivariable logistical regression analysis demonstrated that positive IgM before surgery (OR=7.319, 95%CI 1.669 to 32.103, P=0.008), and longer duration of surgery (OR=1.016, 95%CI 1.003 to 1.028, P=0.013) were independent risk factors of perioperative complications for patients who recovered from COVID-19. Conclusion It is safe for patients recover from COVID-19 to receive lung surgery when symptoms disappeared and the nucleic acid test turned negative. However, positive COVID-19 IgM was an independent risk factor for perioperative complications. We suggest that lung surgery could be performed when the nucleic acid test and COVID-19 IgM were both negative for patients recover from COVID-19 infection.
Objective To compare the analgesic effect, duration and incidence of adverse reactions of liposome bupivacaine and bupivacaine hydrochloride after intercostal nerve block in single-pore thoracoscopic lung surgery. Methods A total of 228 patients in our hospital who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method: a group B with bupivacaine hydrochloride (n=128) and a group LB with liposome bupivacaine (n=110). Intraoperative intercostal nerve block was performed under endoscopy, and the time of first use of analgesic drugs after surgery, cumulative use of opioids 72 h after surgery, incidence of postoperative nausea and vomiting, length of stay and other indicators were evaluated and recorded. Results Visual analogue scale (VAS) scores at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h in the LB group were significantly lower than those in the group B (P<0.05). The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group (P<0.05), and the postoperative hospitalization days in the LB group was shorter than that in the group B, but the difference was not statistically significant.There was no statistical difference between the two groups in postoperative adverse reactions Conclusion Intercostal nerve block with liposome bupivacaine during single-pore thoracoscopic lung surgery can significantly reduce postoperative pain, improve quality of life, and promote recovery. It is worthy of clinical promotion.