Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.
ABSTRACT Covid-19 is a global threat that attracts researchers from all areas to understand the natural history of the disease and its epidemiological parameters. The technological development of vaccines, diagnostic tests, and therapeutic targets has mobilized many resources in a short time. Health technology assessment (HTA), based on a systematic analysis of the properties, effects and/or impacts of health technologies through internationally-validated methods and instruments to assess the quality and methodological rigor of studies that demonstrate effectiveness, efficacy, and safety, is under unprecedented pressure due to the pandemic. This article also reflects on the emergency authorization of the use of treatments and diagnostic tests that conflict with HTA precepts. We will also evaluate non-pharmacological technologies of containment of the disease and their impacts on the domestic and international economy, as well as the judicial interventions that impact the decisions of managers in the exceptional context of the covid-19 pandemic.
RESUMO A Covid-19 é uma ameaça global que atrai pesquisadores de todas as áreas a fim de conhecer a história natural da doença e seus parâmetros epidemiológicos. O desenvolvimento tecnológico de vacinas, testes para diagnóstico e alvos terapêuticos tem mobilizado grande quantidade de recursos em curto tempo. A Avaliação de Tecnologias em Saúde (ATS), baseada em uma análise sistemática das propriedades, efeitos e/ou impactos das tecnologias em Saúde através de métodos e instrumentos validados internacionalmente para avaliar a qualidade e rigor metodológico dos estudos que demonstrem eficácia, efetividade e segurança, está sofrendo pressões, sem precedentes, devido à pandemia. Este artigo traz uma reflexão sobre a autorização emergencial do uso de tratamentos e testes diagnósticos que conflita com os preceitos da ATS. Apresentaremos também uma avaliação das tecnologias não farmacológicas de contenção da doença e seus impactos na economia doméstica e internacional, bem como as intervenções judiciais que impactam as decisões dos gestores no contexto excepcional da pandemia de Covid-19.