Early rehabilitation challenges of surgical patients with COVID-19 infection – a single-arm study

Dušica Simić-Panić; Ksenija Bošković; Slobodan Pantelinac; Aleksandar Knežević; Predrag Jovićević; Apostolos Kozios; Nataša  Janjić; Nikola Nikolić; Larisa Vojnović; Snežana Tomašević-Todorović

doi:10.2298/VSP231228033S

Dušica Simić-Panić *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, †Medical Rehabilitation Clinic, Novi Sad, Serbia
Ksenija Bošković *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; ‡Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
Slobodan Pantelinac *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; †Medical Rehabilitation Clinic, Novi Sad, Serbia
Aleksandar Knežević *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, †Medical Rehabilitation Clinic, Novi Sad, Serbia
Predrag Jovićević Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
Apostolos Kozios University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Nataša Janjić *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Department of Orthopedic Surgery and Traumatology, Novi Sad, Serbia
Nikola Nikolić University Clinical Center of Vojvodina, Department of Abdominal and Endocrine Surgery, Novi Sad, Serbia
Larisa Vojnović *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, †Medical Rehabilitation Clinic, Novi Sad, Serbia
Snežana Tomašević-Todorović *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, †Medical Rehabilitation Clinic, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP231228033S

Keywords: covid-19;, general surgery;, rehabilitation;, treatment outcome.

Abstract

Background/Aim. A very limited amount of data regarding the rehabilitation outcome of surgical patients with COVID-19 is available in the current literature. The aim of this study was to point out the characteristics of early rehabilitation of these patients and determine the predictors of rehabilitation outcomes. Methods. The study was designed as a prospective clinical trial. It included patients who had surgical treatment from April 1, 2022, to March 31, 2023, at the University Clinical Center of Vojvodina, Serbia and either had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperatively or developed coronavirus disease 2019 (COVID-19) within 72 hrs after surgery. The rehabilitation program was planned for each patient according to the type of surgical treatment, age, clinical presentation and severity of the COVID-19, length of immobilization, and comorbidities. Rehabilitation treatment (RT) started with a minimum of one 30-minute daily session, up to three 30-minute sessions daily. Patients were assessed at the beginning of RT and discharge. Outcomes were assessed with the Modified Borg Scale (MBS) for dyspnoea, Barthel index (BI) for activities of daily living, Six-Minute Walk Test (6MWT) for exercise tolerance, and Timed up and Go (TUG) test for balance and lower limb mobility. Results. A total of 81 patients were included in the study. RT was successful for 42 patients (24 female and 18 male) with an average age of 62.10 ± 20.07 years. These patients exhibited significant functional improvement, which was measured by all tests that assessed rehabilitation outcome at discharge: BI (p < 0.001), MBS (p < 0.001), 6MWT (p < 0.001), and TUG test (p < 0.001). The remaining 31 patients had unsuccessful RT. The binary logistic regression analysis has shown that age (p = 0.009), cardiovascular disease (p = 0.017), and malignancy (p = 0.022) were significant predictors of rehabilitation outcome. Conclusion. Results of the present study implicate that individually tailored RT during the acute phase of COVID-19 in surgical patients is very challenging. Advanced age, cardiovascular disease, and malignancy are predictors of unfavorable outcomes, and careful consideration is needed when planning the treatment for these patients.

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