When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA

Figures

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  Fig. 1. Common immunomodulatory effects of SARS-CoV-2 infection and surgical therapy on postoperative mortality. Both SARS-CoV-2 infection and surgical therapy lead to hyperactivation of macrophages through tissue damage of various causes, which first leads to local hyperinflammation. In the following course, a systemic cytokine storm may occur. In this line, lymphopenia and neutrophilia are induced. These SARS-CoV-2 driven effects on the immune system negatively influence on postoperative immune competence of patients and lead to severe postoperative complications such as ARDS, sepsis and thromboembolism. The question now concerns the impact of perioperative SARS-CoV-2 infection on postoperative mortality. ARDS, acute respiratory distress syndrome; PAMPS, pathogen-associated molecular patterns; DAMPS, damage-associated molecular patterns; IL-6, interleukin-6, TNF-α, tumour necrosis factor-α (modified from [75]; Icons from [76, 77])

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  Fig. 2. The different diseases phases of SARS-CoV-2 infection in relation to the severity of COVID-19. The initial phase is characterized by mild infection with cough and fever or even presents asymptomatically. Blood examinations might give evidence for lymphopenia and neutrophilia. The prognosis at this stage is very good. In case of progression of the infection, a transition to a pulmonary phase with clinical and morphological development of pneumonia can be found, which makes frequently hospitalization necessary. The prognosis depends on the severity of pulmonary function impairment or respiratory insufficiency and comorbidities of the affected patients. Transition to the 3rd phase results in the development of a systemic extrapulmonary syndrome with a systemic increase in proinflammatory markers. The prognosis is poor due to the development of sepsis with multiple organ failure and/or ARDS (modified from [96])

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  Fig. 3. The CovidSurg Mortality Score. To estimate postoperative mortality, age, ASA and pulmonary and cardiac comorbidities are considered. Modified from https://covidsurgrisk.app and [140]

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  Fig. 4. Individual and interdisciplinary factors in elective surgery planning. Summary of individual and interdisciplinary factors influencing the planning of operations in patients with and without perioperative SARS-CoV-2 infection. The SARS-CoV-2 icons by [76]