To the Editor,
We have read with interest the article published by Baiocchi Glauco et al. 1 At present, severe acute respiratory syndrome coronavirus 2 (SARS‐Cov‐2) has spread rapidly in the world, and it has become the biggest threat and challenge in the world. In the current environment, this study has a good guiding role for clinical work. Although we believe it is a very interesting topic, we would like to offer the following points for your consideration.
First, in Table 2, 1 we need to compare the surgical methods of the two groups (COVID‐neg group VS COVID‐rec group), such as open surgery and minimally invasive surgery. Many studies have shown that the postoperative complications of minimally invasive surgery are significantly lower than that of open surgery. 2 , 3 , 4 So we need to exclude the influence of surgical methods on the complications of the two groups.
Table 1.
Clinical and demographic characteristics of the 147 patients submitted to surgical procedures from April 22 to July 2, 2020
| Variable 1 | COVID‐nega group n = 98 (%) | COVID‐recb group n = 49 (%) | p value | Total 147 (%) | |
|---|---|---|---|---|---|
| Age, mean; median (range), year | 49.8; 51 (16–81) | 50.1; 52 (13–81) | .86 | 49.9; 51 (13–81) | |
| Body mass index, mean; median (range), kg/m2 | 26.8; 25.9 (16.9–53.9) | 27.6; 27.5 (18.8–43) | .33 | 27.1; 26.6 (16.9–53.9) | |
| Surgical time length, mean; median (range), min | 119.0; 100 (10–670) | 110.2; 79 (10–362) | .54 | 116.1; 93 (10–670) | |
| Hospital stay length, mean; median (range), days | 3.48; 1.0 (0–62) | 3.08; 1.0 (0–47) | .28 | 3.35; 1.0 (0–62) | |
| Gender | Male | 40 (40.8) | 16 (33.3) | .38 | 56 (38.4) |
| Female | 58 (59.2) | 32 (66.7) | 90 (61.6) | ||
| ASAc | 1 and 2 | 82 (83.7) | 44 (89.8) | .31 | 126 (85.7) |
| 3 and 4 | 16 (16.3) | 5 (10.2) | 21 (14.3) | ||
| ECOGd | 0 and 1 | 83 (84.7) | 42 (85.7) | .87 | 125 (85.0) |
| 2 and 3 | 15 (15.3) | 7 (14.3) | 22 (15.0) | ||
| Surgical type | Oncological | 53 (54.1） | 25 (51.0) | .72 | 78 (53.1) |
| Nononcological | 45 (45.9) | 24 (49.0) | 69 (46.9) | ||
| Surgical Department | Gastrointestinal | 17 (17.3) | 10 (20.4) | .73 | 27 (18.4) |
| Gynecology | 16 (16.3) | 10 (20.4) | 26 (17.7) | ||
| Breast | 21 (23.5) | 5 (14.3) | 26 (17.7) | ||
| Skin Cancer | 14 (14.3) | 5 (10.2) | 19 (12.9) | ||
| Urology | 12 (12.2) | 7 (14.3) | 19 (12.9) | ||
| Head and Neck | 11 (11.2) | 7 (14.3) | 7 (14.3) | ||
| Otherse | 8 (8.2) | 4 (8.2) | 12 (8.2) | ||
| Intensive care unit | No | 92 (93.9) | 41 (85.4) | .12 | 133 (91.1) |
| Yes | 6 (6.1) | 7 (14.6) | 13 (8.9) | ||
| Morbidity (Clavien–Dindo)f | none | 84 (85.7) | 41 (83.7) | .74 | 125 (85.0) |
| I | 1 (1.0) | 2 (4.1) | 3 (2.0) | ||
| II | 7 (7.1) | 2 (4.1) | 9 (6.1) | ||
| IIIa | 3 (3.1) | 3 (6.1) | 6 (4.1) | ||
| IIIb | 1 (1.0) | 1 (2.0) | 2 (1.4) | ||
| IVa | 1 (1.0) | 0 (0) | 1 (0.7) | ||
| IVb | 1 (1.0) | 0 (0) | 1 (0.7) | ||
COVID‐neg: patients that had surgeries after a negative RT‐PCR test for SARS‐CoV‐2.
COVID‐rec: asymptomatic patients that had surgeries delayed due to positive RT‐PCR test for SARS‐CoV‐2.
ASA: American Society of Anesthesiologists risk classification.
ECOG: Eastern Cooperative Oncology Group Performance Status.
Others: Vascular surgery, Intervention Radiology, Neurosurgery and Reconstructive Surgery.
Clavien–Dindo: Clavien–Dindo classification of surgical complications.
This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.
Second, in Table 2, 1 the surgical type are divided into Oncological and Nononcological, but there is no comparison of tumor stages in the two groups of tumor patients. As we all know, patients with different tumor stages have different surgical resection range, different trauma, and different probability of complications. Some studies have shown that the incidence of postoperative complications in patients with late tumor staging is higher than that in patients with early tumor staging because of the wide range of surgical resection. 5 , 6
Third, at present, enhanced recovery after surgery (ERAS) has become a global research hotspot, because it can reduce stress response, shorten postoperative hospital stay, reduce postoperative hospital costs and complications, so it is widely used all over the world. 7 , 8 Therefore, the effect of ERAS on the complications of the two groups should be excluded.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
AUTHOR CONTRIBUTIONS
Qiang Hu drafted the letter and Jian Chen and Yuanshui Sun critically reviewed the article.
ACKNOWLEDGMENTS
This study was funded by the Science and Technology Planning Project of Zhejiang Province (No. 2017F30045), Science and Technology Planning Project of Traditional Chinese Medicine(No.2018ZZ004), Gastrointestinal surgery of integrated traditional Chinese and Western Medicine (No. 2017‐XK‐A20).
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