Surgery w #COVID19
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇨🇳" title="Flag of China" aria-label="Emoji: Flag of China"> series in @EClinicalMed: Sx during COVID incubation & 1st manif post-op

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔑" title="Key" aria-label="Emoji: Key">learnings
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warning sign" aria-label="Emoji: Warning sign">Common post-op symptomshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">vigilance & low-threshold for post-op test
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warning sign" aria-label="Emoji: Warning sign"> https://abs.twimg.com/emoji/v2/... draggable="false" alt="⤵️" title="Arrow pointing rightwards then curving downwards" aria-label="Emoji: Arrow pointing rightwards then curving downwards">Outcomes, 20% death
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">Avoiding Sx protects patients
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">Test pre-op!

Detailshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Down pointing backhand index (light skin tone)" aria-label="Emoji: Down pointing backhand index (light skin tone)">
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https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚻" title="Restroom" aria-label="Emoji: Restroom">34 pts w Sx during COVID incubation https://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏻" title="Right pointing backhand index (light skin tone)" aria-label="Emoji: Right pointing backhand index (light skin tone)">post-op symptoms
Denominator of all Sx during that time unknown
Prevalence COVID19 incubation at Sx changes w pandemic evolution
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Small orange diamond" aria-label="Emoji: Small orange diamond">26% pts w cancer
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Small orange diamond" aria-label="Emoji: Small orange diamond">59% w comorbidities
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Small orange diamond" aria-label="Emoji: Small orange diamond">Majority moderate to high-risk Sx

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https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warning sign" aria-label="Emoji: Warning sign"> Presentation w common post-op symptoms
1. Fever 91%
2. Fatigue 53%
3. SOB 44%
4. Myalgia 32%
5. Expectoration 32%
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> be vigilant & low-threshold for test post-op

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COVID19 complications after Sx:
-100% pneumonia
-44% ICU
-33% mech ventilation
-20% death
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">Worse than in general population
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">Older, comorbid, major surgery fare worse

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Timeline

Median
2 days from Sx to 1st symptoms
3 days from Sx to pneumonia
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> QUICK! Potentially quicker than in general population?

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https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warning sign" aria-label="Emoji: Warning sign">Sx during pandemic https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> risk operating during incubation
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⤴️" title="Arrow pointing rightwards then curving upwards" aria-label="Emoji: Arrow pointing rightwards then curving upwards">Risk if COVID19 post-op
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">Delaying Sx not only about resourceshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏻" title="Right pointing backhand index (light skin tone)" aria-label="Emoji: Right pointing backhand index (light skin tone)">protects pts
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">Sx only for urgent cases, prioritize
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">Test pre-ophttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏻" title="Right pointing backhand index (light skin tone)" aria-label="Emoji: Right pointing backhand index (light skin tone)"> if https://abs.twimg.com/emoji/v2/... draggable="false" alt="➕" title="Heavy plus sign" aria-label="Emoji: Heavy plus sign">consider delaying
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">High level suspicion post-ophttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👉🏻" title="Right pointing backhand index (light skin tone)" aria-label="Emoji: Right pointing backhand index (light skin tone)">test quickly

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Full text
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30075-4/fulltext
/7">https://www.thelancet.com/journals/...

Yes, small nb & selection bias. Better than anecdotal single reports
Thoughts? Does it change your decisions? pt counselling? #covid19surgery
@CovidSurg @AnnalsofSurgery @pan_surg @hpbsurgeon1 @ashlie_nadler @biniamkidaneMD @LiangRhea @NirajGusani @sepideh_gholami @motazqadan ...

. @ryanwday @shimulshah73 @DrNCoburn @JoshNgKamstra @AGangiMD @drsuswarner @ksoreide @aneelbhangu @schnitzb @hpb_so @me4_so @juliomayol @LeeOcuin @surgoncmd @ProfDemartines @ProfW_edinsurg @DrCNClarke @dan_abramowitz @Schadi_CRS @UsmaanHameed