Letter to the Editor: "Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection".

Dear Editor, we read with great interest the publication entitled “Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection” [1]. Authors retrospectively analyzed data from 34 patients undergoing elective surgeries during the incubation period of COVID-19, reporting that nearly 45% of patients needed Intensive Care Unit (ICU) after surgery, while mortality rate was 20.5%. Notably, both admission to ICU and mortality rates were significantly higher as compared to previous reports [2]. Authors conclude that surgery may accelerate and worsen COVID-19 disease progression.

Although this report does serve as food for thought, it is difficult not to wonder if the analysis could have been implemented to obtain more truthful findings. We truly believe that a comparison with comorbid- and age-matched, COVID-19 negative control group might have strengthened the reliability of reported results. Indeed, as it stands, the paper is basically a case series and lacks of any information on which policy was followed and which triage performed to select patients for surgery. Probably no triage at all was done, and obviously such a condition is no more accepted anywhere. Additionally, no data are provided regarding outcomes of non-surgical hospitalized patients in their hospitals.

Consequently, we criticize that study design and statistical analysis might be misleading and not entirely appropriate to explore the real impact of COVID-19 on patients undergoing elective surgery. The reported findings seem to be poorly reproducible and generalizable and cannot fully support the conclusion that surgery can accelerate COVID-19 course.

Declaration of Competing Inerest

All authors disclose no financial and personal relationships with other people or organizations that could inappropriately influence their work.