The Effect Of Anesthesia And Surgery On Postoperative Lymphocyte Count, Neutrophyl-Lymphocyte And Platelet-Lymphocyte Ratio In Covid-19 Patients

Abstract

Objectives: Anesthesia applications and surgery can cause not only immediate immune dysfunction, but also an early systemic inflammatory response. Therefore, they can adversely affect the course of coronavirus disease 2019 (COVID-19). In our study, we aimed to retrospectively evaluate the effect of anesthesia and surgical procedures on lymphocyte count, neutrophil- and platelet-lymphocyte ratios (PLR), and post-operative prognosis in COVID-19 patients undergoing emergency surgery. Methods: The demographic, clinical, and laboratory data of 14 patients with pulmonary involvement suggestive of COVID-19 in computed tomography performed preoperatively and who were taken to emergency surgery were examined. Pre- and post-operative total leukocyte, neutrophil, lymphocyte counts, neutrophil-lymphocyte ratio (NLR) and PLR, C-reactive protein, lactate dehydrogenase, ferritin, liver enzymes and kidney function test results, post-operative complications, intensive care (ICU) admission, and presence of mortality were examined. Results: In the pre-operative period, 28.6% patients were symptomatic and 75% of these patients had fever. There was a significant decrease in lymphocyte counts in the first 24 h postoperatively compared to the pre-operative period (p<0.028). There was no significant change in NLR, PLR, and other parameters. In these patients, post-operative complications were 35.5%, pulmonary complications were 21.4% (acute respiratory distress syndrome 7.1%, pneumonia 14.3%), ICU admission was 50%, and mortality was 24%. Conclusion: In the early post-operative period after anesthesia and surgery in COVID-19 patients with pulmonary involvement who undergo emergency surgery, lymphocyte count is affected more severely compared to NLR and PLR and decreases significantly. In these patients with impaired immune response, anesthesia and emergency surgical interventions may increase the risk of post-operative pulmonary complications and mortality