DISCUSSION
Developing COVID-19 during the immediate postoperative period,
regardless of the nature of surgery, carries a high mortality and
morbidity related to respiratory complications [2-4].
In emergencies there is no option to wait for the swab results, hence
the surgical indication outweighs the risk of COVID-19. However, in
urgent cases, with margin to wait for the screening results we
encountered a proportion of patients who were COVID-19 positive with
mild or no symptoms.
The ideal convalescence period after having tested positive for COVID-19
is unknown, especially if no symptoms or abnormalities in the chest
imaging. We believe it is important to manage each case individually,
and when time permitting, to wait until negative for COVID-19 testing or
drastically reduced viral load and resolution of the radiological
infiltrates (if any).
Accuracy of the COVID-19 diagnostic tests is still suboptimal, with a
high percentage of false negatives. Furthermore, a positive test does
not necessarily indicate infectious virus particles in a patient with
resolving infection. The Ct value can be seen as a pseudo-measure of the
viral load (the lower the Ct value, the higher the viral concentration)
and patients with COVID-19 with Ct above 24-26 could be considered
non-contagious [5].
In our series, all patients who required urgent surgery had Ct values
above that threshold and were probably not infectious but delaying
surgery also allowed resolution of the systemic inflammatory reaction
and thus did not see any postoperative complications.
It might not be necessary to wait until total resolution of radiological
changes or a negative PCR result but further studies on a larger volume
of patients are needed to confirm this.