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. 2022 Mar 21;407(4):1315–1332. doi: 10.1007/s00423-022-02495-8

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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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])