Edited by: Philip Frank Stahel, Rocky Vista University, United States Reviewed by: Robert W. Cross, University of Texas Medical Branch at Galveston, United States Paolo Bernante, University of Bologna, Italy *Correspondence: Mark M. Walsh [email protected] †Deceased Speciality section: This article was submitted to Visceral Surgery, a section of the journal Frontiers in Surgery Received: 04 March 2022 Accepted: 05 April 2022 Published: 04 May 2022 Citation: Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS and Walsh MM (2022) Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front. Surg. 9:889999. doi: 10.3389/fsurg.2022.889999 Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation Connor M. Bunch1, Ernest E. Moore2, Hunter B. Moore2, Matthew D. Neal3, Anthony V. Thomas4, Nuha Zackariya4, Jonathan Zhao5, Sufyan Zackariya5, Toby J. Brenner5, Margaret Berquist5, Hallie Buckner5, Grant Wiarda5, Daniel Fulkerson4,6, Wei Huff4,6, Hau C. Kwaan7, Genevieve Lankowicz5, Gert J. Laubscher8, Petrus J. Lourens8, Etheresia Pretorius9,13, Maritha J. Kotze10, Muhammad S. Moolla11, Sithembiso Sithole11, Tongai G. Maponga12, Douglas B. Kell9,13,14, Mark D. Fox4, Laura Gillespie15, Rashid Z. Khan16, Christiaan N. Mamczak4,17, Robert March18, Rachel Macias4,19, Brian S. Bull20† and Mark M. Walsh4,5* 1Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States, 2Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States, 3Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States, 4Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States, 5Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States, 6Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States, 7Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States, 8Mediclinic Stellenbosch, Stellenbosch, South Africa, 9Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa, 10Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa, 11Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa, 12Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, 13Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom, 14The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark, 15Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States, 16Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States, 17Department of Orthopaedic Trauma, Memorial Hospital South Bend, South Bend, IN, United States, 18Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States, 19Department of Plastic and Reconstructive Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States, 20Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, United States Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data— in conjunction with the recent American Society of Anesthesiologists guidelines—offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon’s preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient’s fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical REVIEW published: 04 May 2022 doi: 10.3389/fsurg.2022.889999 Frontiers in Surgery | www.frontiersin.org 1 2022 | Volume 9 | Article 889999 JULY 2022 | The Surgical Technologist | 301 Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation
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