Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. Methods A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. Results A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). Conclusion The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. Registration This systematic review and meta-analysis was registered in Prospero’s international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.

Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

“…The youngest of our patients was 70 years, and most of them presented comorbidities, frequently hypertension and diabetes. Moreover, COVID-19-positive patients with hip fractures, who may be similar to those with periprosthetic fractures except for the fact that the latter usually undergo a more invasive procedure, have shown a higher 30-day mortality rate compared with non-COVID-19 infected cases [ 7 ], and, more broadly, a meta-analysis revealed a very high global rate of post-operative mortality among COVID-19 patients of 20% and a post-operative intensive care unit (ICU) admission rate of 15% [ 34 ]. The patient’s immune function has been reported as a major determinant of the disease’s severity [ 35 ], and surgery may cause both an immediate impairment of immune function and an early systemic inflammatory response [ 36 ].…”

A fatal association of COVID-19 and acute complicated Type-B aortic dissection: Interventional management in a difficult situation

“…This case clearly demonstrates that the COVID-19 related mortality is quite high among patients who underwent major procedures. 2 , 3 Although at what point of time patient developed aortic dissection is not clear. Our patient gives no history of backache, chest pain, loss of consciousness or abdominal pain; so there was no suspicion of aortic dissection at presentation.…”

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

“…COVID-19-related recommendations and guidelines, produced by health authorities and organizations, such as WHO, US-CDC, ECDC, the American College of Surgery and the Robert Koch Institute, were searched, assessed and referenced [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] ] up to January 31 st , 2021. After consideration of all these guidelines the WHO-Patient Care Checklist was selected as a “master document”, modified and adapted, to be shared with partners in relevant medical and clinical fields.…”

“…Thus COVID-19 may change the management of acute appendicitis to favour non-operative management, which has now been shown to be safe and effective in the short-term [ 3 ]. A meta-analysis confirmed a high rate of postoperative mortality among COVID-19 patients of 20% and a postoperative ICU admission rate of 15% [ 4 ]. Consequently, it was suggested that there is an urgent need for investigations by governments and health providers into measures that ensure safety of patients and healthcare workers (HCW), as elective surgery restarts.…”