The impact of immune dysfunction on perioperative complications in surgical COVID-19 patients: an imperative for
Vincent P Stahel1, Samson D Blum2, Pratibha Anand3
1University of Colorado (CU), Boulder, CO, 80309, USA. vincent.stahel@gmail.com.
Insights
Surgical patients with COVID-19 face higher risks of complications and death. Immunonutrition may help mitigate immune dysfunction, reducing surgical risks in these patients.
Area of Science:
- Surgical patient safety
- Immunology
- Infectious disease
Background:
- Coronavirus disease 2019 (COVID-19) significantly increases perioperative complications and mortality in surgical patients.
- Immune dysfunction, characterized by complement activation and cytokine storm, is a primary driver of postoperative infections and thromboembolic events.
- Existing therapies like anti-inflammatory agents offer partial mitigation of hyperinflammation.
Discussion:
- Immunonutrition presents a novel strategy to address COVID-19-induced immune dysregulation.
- This nutritional approach aims to modulate the immune response, potentially reducing surgical complications.
- The focus is on proactive intervention to enhance patient resilience.
Key Insights:
- COVID-19 profoundly impacts surgical patient outcomes beyond pneumonia risk.
- Microvascular injury and thromboembolism are linked to COVID-19's immune consequences.
- Immunonutrition offers a promising, proactive approach to patient management.
Outlook:
- Further research into immunonutrition protocols for COVID-19 surgical patients is warranted.
- This strategy could significantly improve postoperative outcomes and reduce mortality.
- Integrating immunonutrition may become a standard of care for optimizing surgical safety in the context of viral pandemics.
Abstract:
Surgical patients with coronavirus disease 2019 (COVID-19) are vulnerable to increased perioperative complications and postoperative mortality, independent of the risk for contracting COVID-19 pneumonia after endotracheal intubation for general anesthesia. The presumed root cause of postoperative infections, microvascular soft tissue injuries and thromboembolic complications is largely attributed to the profound immune dysfunction induced by COVID-19 as a result of complement activation and the "cytokine storm". The empirical therapy with anti-inflammatory agents has been shown to attenuate some of the adverse effects of systemic hyperinflammation in COVID-19 patients. In addition, the proactive concept of "immunonutrition" may represent a new promising avenue for mitigating the complex immune dysregulation in COVID-19 and thereby reduce the rates of surgical complications and postoperative mortality. This letter provides a narrative summary of the current state-of-the-art in the field of immunonutrition as it pertains to surgical patient safety in COVID-19 patients.
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