At the end of 2019, cases of an unknown respiratory infection were reported in the cityof Wuhan in China. It was determined that the cause of this infection was a new virusbelonging to the coronavirus family, which was named SARS-CoV-2. After the virus spreadworldwide, the World Health Organization (WHO) declared it a pandemic. The clinicalpicture and disease caused by the virus were named COVID-19 (1). According to the WHO'sdata on 29.01.2022, the number of cases worldwide has exceeded 365 million, and thenumber of deaths has exceeded 5 million (2). Fever, cough, fatigue, shortness of breath,myalgia, sore throat, and headache are the main symptoms of COVID-19. Less frequently, itcan cause nausea, vomiting, and diarrhea. The disease has a broad spectrum ranging frommild illness to severe illness that can result in death (3). In a study analyzing thedata of approximately 72,000 patients in China, it was reported that 81% of the patientshad no lung involvement or minimal involvement, 14% had severe involvement, and 5% hadrespiratory failure, shock, or multiple organ failure (4).Attention is drawn to the long-term complications of COVID-19, such as myocarditis, heartfailure, arrhythmia, dyspnea, oxygen dependence, impaired respiratory function tests,increased venous/arterial thromboembolism, decreased fitness, muscle and joint pain,increased anxiety-depression, post-traumatic stress disorder, and renal damage (5). Ithas been emphasized that patients who have recovered from COVID-19, especially olderindividuals and those with severe illness, are at risk of sarcopenia (7). It has beensuggested that in patients who have recovered from COVID-19, direct viral damage,decreased physical activity level, and malnutrition result in decreased fitness andsarcopenia, which could be associated with increased morbidity in cancer surgeries (8).It is reported that postoperative complications and deaths are higher in active COVID-19patients than in those who do not have active disease (9). In a multicenter study, it wasstated that postoperative pulmonary complications were observed in half of the patientswho had COVID-19 during the perioperative period, and this condition was associated withhigh mortality. Most of these patients are those who need emergency surgicalinterventions (10).According to studies in the literature, COVID-19 has multi-systemic effects, and some ofthese effects continue in the long term. It has been shown that the perioperative periodwith COVID-19 positivity is associated with higher pulmonary complications and mortality.It has been suggested that having had COVID-19 in the past may lead to worsepostoperative outcomes. The studies in the literature were mostly conducted on patientswho had surgery during the perioperative period while having COVID-19. Most of thepatients required emergency surgical interventions. The effect of the patients'functional level on postoperative outcomes has not been examined. Our study focuses onthe intraoperative and postoperative period of thoracic surgery patients who underwentsurgery in the long term after COVID-19.
Patients over the age of 18, who are planned to undergo thoracotomy, will be recruited.
Those volunteers whose COVID-19 infection is confirmed by PCR test will form the COVID-19
patient group, while others will form the control group who did not have COVID-19. The
patient group to be operated on and followed by the Department of Thoracic Surgery of the
Ankara University, Faculty of Medicine will be analyzed.
Before starting the evaluations, the patients will be asked to review the informed
consent form and give their consent to participate in the research. The sociodemographic
data (name, surname, file number, date of birth, height, weight, marital status,
education level, occupation, contact number) and medical history (systemic diseases and
their duration, drugs used continuously and their duration) of the patients who agree to
participate in the study will be recorded.
The ASA (American Society of Anesthesiologists) score will be determined in the
preoperative period. Hemoglobin values before the operation will be recorded. It will be
queried whether the participants had COVID-19, and in the group that had it, the date of
COVID-19 infection, whether oxygen therapy was received before COVID-19, inhaler and
BPAP-CPAP usage status, the presence of COPD, severe emphysema, uncontrolled asthma, OSAS
(Obstructive sleep apnea syndrome), or previous pulmonary surgery history will be
recorded. It will be queried whether imaging was performed with computed tomography
during COVID-19 diagnosis and follow-up, and if performed, whether there was lung
involvement and its percentage will be recorded. Medical treatments received by the
patient during COVID-19, need for ventilation support will be noted. The duration of
hospitalization in the inpatient and intensive care units due to COVID-19 will be
recorded. The need for oxygen support after discharge due to COVID-19 will be queried.
ARISCAT scores will be determined in both groups. Arterial blood gas results taken before
the operation will be recorded. Predicted postoperative forced vital capacity (FVC),
forced expiratory volume in 1 second (FEV1), and DLCO (diffusing capacity of the lung for
carbon monoxide) values will be determined before the operation.
Jamar dynamometer will be used to measure grip strength (Mathiowetz 1984). Assessment
with Jamar dynamometer will be performed during the preoperative assessment, discharge
phase, and 1-month control after the operation. Patients will be asked to squeeze the
dynamometer as hard as they can while their upper extremities are positioned
appropriately. Measurements will be taken three times for each side.
To evaluate lower extremity muscle strength and balance, a 5-repetition sit-to-stand test
will be applied (Munoz-Bermejo 2021). This test will be performed during the preoperative
assessment, discharge phase, and 1-month control after the operation. Patients will be
asked to stand up from the chair five times while sitting on the chair. The time required
for each patient to complete the test will be recorded.
Inclusion Criteria:
- The Informed Consent Form must be signed by the patient
- Being over 18 years old
- The plan is to undergo pneumonectomy, lobectomy, segmentectomy, or various degrees
of lung resection surgery
Exclusion Criteria:
- Informed Voluntary Consent Form not signed by the patient
- The presence of contraindications for the administration of cardiopulmonary exercise
testing
- Lack of mental and psychological competence to complete the assessment and testing
phases The presence of musculoskeletal problems that could hinder the implementation
of evaluation and testing stages
Ankara University Faculty of Medicine
Ankara, Turkey
Investigator: CIGDEM YILDIRIM GUCLU, Associated Professor
Contact: +90 (532) 457 66 48
drcigdemyldrm@yahoo.com.tr
Investigator: CIGDEM YILDIRIM GUCLU
Not Provided