Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Abstract

Background The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking. Methods We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms “COVID-19″ or “SARS-CoV-2″ and “Surgery” or “Operation” for all published articles on COVID-19 from December 1, 2019 to October 5, 2020. Findings A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality ( r = 0.891, p < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality ( r = 0.675, p = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected. Interpretation COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE). Funding Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.

Determinants on COVID-19 Case Fatality Rates of Cities in China: A Logit-NB Hurdle Model Analysis

“…AQI represents air quality, and climatic conditions are measured by humidity and temperature. Demographic characteristics consist of age, ethnicity, gender structures, the proportion of the population with non-agricultural hukou and population density, directly connected to the COVID-19 mortality [18]. Socioeconomic factors incorporate GDP per capita, the percentage of unemployment, and the insurance coverage, which re ect people's socioeconomic status that will in uence their health outcomes [20].…”

“…As an essential environmental factor, climatic conditions also in uence the death rates of COVID-19 [11], mainly measured by temperature and air humidity [12][13][14]. Demographic characteristics have remarkable effects on the mortality of patients with COVID-19: age is the dominant factor; besides, gender, race, ethnicity, medical history (such as comorbidity and obesity), and neighborhood characteristics also play a signi cant role in determining the CFR [15][16][17][18]. The socioeconomic factors exert speci c impacts on the COVID-19 spread, including income, unemployment, inequality, poverty, total population, population density, human mobility, medical resources [17,[19][20][21].…”

Author's reply - factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

“…We thank Lawday et al. for their comments on our paper [1] . We concur with Lawday and colleagues that cohort studies should have been included in our meta-analysis in order to provide more comprehensive information.…”

“…We concur with Lawday and colleagues that cohort studies should have been included in our meta-analysis in order to provide more comprehensive information. In the 47 studies included, 42 were case reports/series, and data from these case reports/series were directly combined and analyzed to obtain the conclusion that the perioperative mortality of patients with COVID-19 undergoing surgery was 6% [1] . While ideally/theoretically, cohort studies should be included in this meta-analysis, direct combining data of different literature types may affect the reliability of meta-analysis results.…”

Reply to: “Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis”

“…We read with interest ‘Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis’ by Wang et al in EClinicalMedicine. [1] Protecting patients from perioperative SARS-CoV-2 infection at present is a priority to surgeons. However, we must express concerns about the quality of methodology in this manuscript .…”