Single-Institution Study Examines Safety of Routine Thoracic Surgery, Examinations During the COVID-19 Pandemic

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A study published by Wang et al in JTO Clinical and Research Reports compared surgeries performed at one Chinese hospital in 2019 with a similar date range during the COVID-19 pandemic. Researchers found that routine thoracic surgery and invasive examinations were performed safely during the COVID-19 pandemic.

Single Surgical Team

Wentao Fang, MD, Chief Director of the Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, and his colleagues analyzed the number of elective procedures conducted by a single team between 2019 and 2020, and compared the clinicopathologic characteristics, surgical procedures, and perioperative results of these procedures in 2020 with the corresponding period in 2019.

After the first case of COVID-19 was reported in Wuhan, China, in December 2019, the confirmed local cases in Shanghai reached peak level between late January and early February 2020. Cases then rapidly decreased by late February after stringent mitigation policies were put into place by the Shanghai municipal government.

To prevent potential COVID-19 infection among patients and hospital staff, multiple measures were undertaken and adjusted according to policies and procedures put in place during the pandemic in Shanghai.

Volume and Safety

In terms of surgical volume, the number of cases declined by 14.1%—from 263 in 2019 to 226 in 2020.

“Importantly, neither medical staff nor patients were diagnosed of COVID-19 infection during this time,” said Dr. Fang.

All 226 patients received spirometry examinations; 7 patients underwent esophagoscopy and 16 underwent bronchoscopy before operations. All the surgical procedures were safely performed under the general anesthesia with double-lumen tube intubations.

More than a quarter (27.7%, n = 65) of the patients were current or former smokers. There were 26 patients (11.5%) who underwent surgery after neoadjuvant therapy in 2020, which was similar to those in 2019 (34 patients, 12.9%).

Dr. Fang reported that the number of surgical procedures began to bounce back from its lowest point in February 2020, as the local situation of COVID-19 showed signs of improvement, and then surpassed the sum of the same period last year in April 2020, when full work resumption was upcoming.

“We noticed that postoperative complication rate decreased in the first 2 months of 2020 during the peak of the COVID-19 pandemic, when surgical indication was strictly reconsidered, and surgical volume was largely decreased…. Complication rates in each month of 2020 were all lower than in the same month of last year,” said Dr. Fang.

“The COVID-19 pandemic had a significant impact on the elective operations for thoracic diseases for a delay of almost 2 months. However, routine thoracic surgery as well as invasive examinations could be performed safely if careful screening and examinations of patients and effective protection of medical staffs are well-completed during the full work resumption in low-risk areas of COVID-19,” concluded Dr. Fang.

Disclosure: For full disclosures of the study authors, visit

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