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. 2020 Oct 12:14:37.
doi: 10.1186/s13037-020-00262-6. eCollection 2020.

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

Semagn Mekonnen Abate  1 , Bahiru Mantefardo  2 , Bivash Basu  3
Affiliations

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

Semagn Mekonnen Abate et al. Patient Saf Surg. .

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.

Keywords: COVID-19; Mortality; Perioperative; Prevalence; Surgery.

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Conflict of interest statement

Competing interestsThe authors declare that there are no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow chart
Fig. 2
Fig. 2
Forest plot for the prevalence of mortality among hospitalized patients with COVID: The mid-point of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 3
Fig. 3
Forest plot for the subgroup analysis of the prevalence of perioperative mortality among surgical patients with COVID-19 by the urgency of surgery: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence. Forest plot for the prevalence of perioperative morbidity among surgical patients with COVID-19: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 4
Fig. 4
Forest plot for the prevalence of perioperative complication among surgical patients with COVID-19: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 5
Fig. 5
Forest plot for the length of hospital stay among surgical patients with COVID-19: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 6
Fig. 6
Forest plot for rates postoperative ICU admission among surgical patients with COVID-19: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 7
Fig. 7
Forest plot for subgroup analysis of the prevalence of clinical presentation among surgical patients with COVID-19 by types of presentations: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled prevalence
Fig. 8
Fig. 8
Funnel plot to assess publication bias. The vertical line indicates the effect size whereas the diagonal line indicates the precision of individual studies with a 95% confidence interval
See this image and copyright information in PMC

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