key: cord-277941-8twjdyjc
authors: Scarci, Marco; Raveglia, Federico
title: Commentary: The double responsibility of the thoracic surgeon at the time of the pandemic: a perspective from the North of Italy
date: 2020-04-10
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.04.003
sha: 
doc_id: 277941
cord_uid: 8twjdyjc

nan

The rapid spread of the COVID-19 pandemic in the north of Italy at the end of February 2020 10 has taken the local healthcare system by surprise because of exponential increase in the number of daily 11 cases and sheer number of those needed admission to ICUs (1). In the emergency, with hospitals' 12 services being reconfigured, thoracic surgeons still tried to maintain a more or less regular operating 13 schedule amid uncertainties regarding the safety of the patients and healthcare operators (2) (3). 14 Although China was ahead of us in terms of experience there were no data available regarding thoracic 15 surgery and the potential post-operative increase in morbidity and mortality. 16

The first meaningful evidence emerging from this study is the proportion of severe and critical disease 17 between thoracic surgery patients and the whole COVID population that was 27.3% and 36.4% versus 18 2% and 13.8% respectively, strongly suggesting the possibility that surgery, in itself, can negatively 19 affects outcomes. These data seems to be consistent with general surgery (4)(5). This article has certainly the merit to raise awareness of the problem among thoracic surgical 39 community; unfortunately, the small sample size and the heterogeneity of surgical interventions (lung 40 and esophageal cancer, non-malignant diseases) weakens the recommendations that can be drawn. 41

Therefore, although the data presented here are not conclusive, they help to set the basis for a multi-42 centric case series, with identification, on a larger sample, of pre and post-operative prognostic factors 43 that can help surgeons to make the right decisions in this difficult scenario. 44

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