Table 2.
Surgical data and patient outcomes.
| Author, year | Surgical service | Study Duration | Description of lockdown | N total number of surgeries | N elective surgeries (total; before outbreak; during outbreak) | N urgent surgeries (total; before outbreak; during outbreak) | N cancer surgeries (total; before outbreak; during outbreak) | CD I-II | CD III-IV | CD V | ACGME Stage |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Angel, 2020 | ICU | Mar 10 to Apr 15, 2020 | – | – | – | – | – | 2 | |||
| Barca, 2020 | Maxillofacial surgery | Feb to Apr 2020 | – | 33 | 0 | 20 | 13 | 2 | |||
| Berardi, 2020 | Surgical oncology, transplant surgery | Mar 9 2020 to Apr 24 2020 | Only major oncologic surgeries and transplantations. Outpatient clinics were significantly reduced. Multidisciplinary meetings were moved to a webinar platform. | 2019: 115; 2020: 72 | 0 | 12 | 60 | Major complications not specified (n = 5) | Death due to hyperacute allograft dysfunction (n = 1) | 2 | |
| Bogani, 2020 | Gynecologic oncology | Feb to Mar 2020 | – | 5 | 5 | Prolonged hospital course (n = 2); Post-op COVID-19 diagnosis (n = 5) | Death (n = 2) | – | |||
| Bundu, 2014 | Various | Jun 2013 to Feb 2015 | Elective surgeries cancelled starting July 2014 | 1444 | – | – | – | – | |||
| Cai, 2020 | Head and Neck | Feb 1 to Mar 10, 2020 | In-hospital treatment of benign or slow-progressing tumors postponed until after epidemic stabilization | 97 | 97 | Postop fever (n = 7) | 2 | ||||
| Cai, 2020 | Thoracic | Jan 2020 | None (before the outbreak was official declared) | 139 | – | – | 7 | Death due to COVID-19 pneumonia (n = 3) | – | ||
| Chao, 2020 | ICU | – | 2 | ||||||||
| Chee, 2004 | Various | Feb to Apr 2003 | Elective surgeries cancelled | 41 | – | – | – | – | |||
| Chen, 2020 | Obstetrics | Jan to Feb 2020 | – | 17 | 14 | 3 | 0 | None | None | – | |
| Cheung, 2020 | Orthopedics | Mar 1 to May 22 2020 | – | 10 | 0 | 10 | 0 | Supplemental oxygen (n = 5); blood transfusion (n = 10); presumed VTE (n = 1) | Acute Kidney injury (n = 1) | Death due to respiratory failure (n = 1) | – |
| Chow 2020 | ENT | Apr 1, 2020 and Apr 17, 2020 | – | 5 | – | – | 2/5 during outbreak | – | |||
| Couto, 2020 | Various | Mar to Apr 2020 | Elective aesthetic and reconstructive surgery cases were stopped after recommendations by the state of Texas. | – | |||||||
| Cruz, 2020 | ICU | Apr 2020 | – | – | |||||||
| Cui, 2020 | ENT | Jan to Mar 2020 | Outpatient clinics and emergency departments were closed for two of the hospitals. The larger hospital eliminated nonurgent visits, cancelled elective surgery, and avoided upper tract endoscopic exams | 3 | 1/6 as many elective surgeries performed during the pandemic | 3 | 0 | Coma (n = 2) | Death due to epistaxis (n = 1) | – | |
| Deng 2020 | ENT | Feb to March 2020 | – | – | – | – | – | – | |||
| Doglietto, 2020 | Various | Feb to Apr 2020 | Most elective surgeries were stopped. | 41 | 4 | 37 | Local complications n = 3); post-op COVID-19 diagnosis (n = 8) | Thrombotic complications (n = 4), hemorrhagic complications (n = 15), pneumonia (n = 18), delirium (n = 1) | Acute respiratory failure (n = 6), cardiogenic shock (n = 2), | – | |
| Doran, 2020 | HPB and Liver Transplant | Mar 2020 | Routine patient isolation for 7 days before surgery | 2 | 0 | 0 | 2 | Post-operative COVID pneumonia requiring oxygen (n = 1) | – | ||
| Fregatti, 2020 | Surgical oncology | Mar 9 to Apr 9 2020 | – | 85 | 0 | 0 | 85 | 2 | |||
| Gallego, 2020 | General Surgery | Mar 2020 | Elective surgeries cancelled after pandemic declared | 189 (number of admission and interventions decreased by 52.7%) | 153 | In the preceding month, 104 performed; after outbreak, 36 performed | NS but oncology procedures reported as urgent | Death due to respiratory failure from COVID-19 (n = 3) | 2 | ||
| Gao, 2020 | General surgery | Jan 23 to Mar 23, 2020 | – | 4 | 0 | 4 | 0 | None | None | – | |
| Garcia-Portabella, 2020 | Orthopedic Surgery | Mar to Apr 2020 | – | 11 | 11 | – | |||||
| Gou, 2020 | Pancreatic | Feb 2020 | – | 1 | 0 | 1 | – | Post-operative COVID-19 diagnosis (n = 1) | – | ||
| Hassan 2020 | Neurosurgery | Mar 23 – Apr 2020 | Elective procedures were cancelled | 91 | 0 | 91 | Death (n = 7) | 2 | |||
| He, 2020 | Vascular surgery/Anesthesiology | – | – | 4 | – | 4 | – | – | |||
| Huang, 2020 | Thorascopic lung surgery | Jan 1 2020 to Mar 31 2020 | Lung surgeries suspended since Jan 20 2020 | 3 | – | – | 3 (during outbreak) | COVID-19 infection (n = 3) | Death due to COVID-19 (n = 2) | – | |
| Khalafallah, 2020 | Neurosurgery | Mar 18 to Apr 17 2020 | Elective and nonelective procedures were cancelled (7600 cancelled during study period). A 68.89% reduction in total cases between Apr 2019 and Apr 2020. Increased adoption of telemedicine in outpatient setting, and teleconferencing services for educational activities. | 20 | 20 | 2 | |||||
| LeBrun, 2020 | Orthopedic | Mar 20 to Apr 24 2020 | – | 59 | 0 | 59 | Postoperative hypoxia (n = 18) | Hypoxia requiring intubation and admission to ICU (n = 3) | Death due to COVID-19 (n = 5), 2/5 preoperative 3/5 postoperative; Death due to cardiac arrest intraoperatively (n = 1); | – | |
| Lei, 2020 | Various | Jan to Feb 2020 | – | 34 | 29 | 0 | 5 | COVID pneumonia (n = 34), secondary infection (n = 10), arrhythmia (n = 8) | Acute respiratory distress syndrome (n = 11), shock (n = 10), acute cardiac injury (n = 5), acute kidney injury (n = 2) | Death (n = 7) | – |
| Leong, 2020 | Neurosurgery | Feb to Apr 2020 | All non-essential leave (inclusive of overseas and local conference leave) was cancelled. Strict social distancing policy. | 2 | |||||||
| Li 2020 | Kidney Transplant | Jan 20 to Mar 1, 2020 | 0 | 18 | – | 18 (100%) during outbreak | – | Delayed recovery of transplanted kidney function (n = 1) | Acute transplant rejection (n = 1) | – | |
| Luong-Nguyen, 2020 | General surgery | Mar to Apr 2020 | – | 11 | – | – | 5 | One unspecified post-op complication (n = 11) | Death secondary to respiratory failure (n = 1), death from candidal septicemia (n = 1) | – | |
| Madenelo, 2020 | Urology | Mar 11th 2020 to Apr 1st 2020 | State of emergency declared and social isolation instituted | 11 | – | 11; 18 during same period in 2019; | – | – | |||
| Maniscalco 2020 | Orthopedics | Feb 22 2020–Apr 18 2020 | – | 121; 169 during same period in 2019 | – | 121 (100%) during outbreak | – | Death (cardiac arrest n = 8; multi-organ failure n = 3; progression of neoplasm n = 2; renal failure n = 1; brain hemorrhage n = 1; septic shock n = 1; total n = 17); Death total n = 6 during same period in 2019 | – | ||
| Maniscalco, 2020 | Orthopedics and Traumatology | Feb 25 to Mar 31 2020 | All planned activities stopped, ICU capacity troped, hospital converted into designated “COVID-19 hospital” | 96; 125 same time period 2019 | – | 96 | – | – | |||
| Meyer 2020 | Spine | Mar 17 2020–Apr 17 2020 | Elective surgeries were cancelled | 62 | 0 | 62 (100%) during outbreak | – | – | |||
| Morrison 2020 | ENT | Mar 18 – Apr 21–2020 | Elective surgeries were cancelled, limited OR space, limited clinics | 103 | 0 | 103 (100%) during outbreak | – | 2 | |||
| Nazer, 2007 | Cardiac | Jan to Feb 2015 | None | 6 | 1 | 5 | 0 | Subdural hematoma (n = 1), perioperative MI (n = 1) | |||
| Ng 2020 | Vascular | Feb–Mar 2020 | Elective surgeries were cancelled | 291 | 2 | ||||||
| Oh, 2020 | Obstetrics | Feb 26 to Apr 3 2020 | The hospital’s delivery center was designated for suspected or confirmed mothers of COVID-19 only | 8 | 0 | 8 | 0 | No complications | – | ||
| Paramore 2020 | Urology | Mar 23 2020–Apr 9 2020 | Cancellation of routine elective surgery, limit surgical resources to risk-stratified patients | 52 | – | 6 (11.5%) during outbreak | – | UTI (n = 2) | – | ||
| Patel, 2020 | General Surgery | Mar to Apr 2020 | Outpatient clinics and endoscopic procedures decreased to limit spread of virus; elective non-cancer surgery cancelled. | 20 | 20 | – | |||||
| Peng, 2020 | Thoracic | Jan 2020 | Elective surgeries cancelled on last day of study period | 121; 11 | 84 cancelled | 121; 0 | 4/11 patients in case series had cancer surgery; 11 | Prolonged air leak (n = 1) | Sudden cardiac arrest from hypokalemia (n = 1) | Death from respiratory failure due to COVID-19 (n = 3) | – |
| Ralli, 2020 | Otolaryngology | Feb to Apr 2020 | Elective surgeries cancelled. Emergent and oncology cases only. | 96 (50.77% decrease in overall number of surgical procedures) | 0 | 22 | Same timepoint 1 year ago, 195 procedures; 74 after outbreak | – | |||
| Rossi, 2020 | Orthopedic Oncology | Dec 2019–Apr 2020 | Elective orthopedic surgery was forced to stop to allow the healthcare system to face the emergency. | 79 | 79 | 0 | 0 | 0 | – | ||
| Saban, 2020 | Ophthalmology | – | – | 3 | – | ||||||
| Schneider, 2020 | Orthopedic Surgery | – | Temporary ban on elective surgery and outpatient clinics, rigorous visitor restrictions, and compulsory facemasks for all HCW | – | |||||||
| Shrikhande, 2020 | Various | Mar to Apr 2020 | 494 | 494 | Minor CDI-II + postop COVID-19 | – | |||||
| Taha, 2020 | Otolaryngology | Mar to Apr 2020 | Elective surgeries cancelled | 12 | 0 | 12 | 0 | – | |||
| Tan, 2020 | Neurosurgery | - (published Mar 2020) | Operations for patients with relatively stable condition postponed | – | – | – | – | – | |||
| Tankel, 2020 | General Surgery | Feb to Apr 2020 | – | 130 | 0 | 130 (202 in 7 wks preceding) | 0 | “Serious complication " (n = 1) | – | ||
| Tien, 2005 | ICU; Emergency OR | May 2013 | – | 1 | 0 | 1 | 0 | Death from presumed abdominal compartment syndrome (n = 1) | – | ||
| Turri-Zanoni, 2020 | Otolaryngology | Feb to Apr 2020 | – | 13 | 13 (tracheostomy procedures labeled as elective in the study, performed in OR) | – | – | Death due to COVID-19 (n = 5) | – | ||
| Valdivia, 2020 | Vascular surgery | Mar 14 to May 14 2020 | Only urgent surgeries were performed, vascular surgery department was partially converted to COVID-19 unit | 60 | 0 | 60 | 0 | Death due to acute respiratory distress syndrome (n = 1) | 2 | ||
| Wang, 2020 | Neurosurgery | – | – | 5 | 0 | 5 | 0 | Death due to COVID-19 related complications (n = 3) | – | ||
| Wong, 2004 | Obstetrics | Apr-03 | – | 3 | 0 | 3 | – | Wound infection (n = 2) | – | ||
| Yang, 2020 | Gynecologic oncology | Jan to Feb 2020 | – | 189 | 0 | 0 | 189 | COVID pneumonia (n = 3) | – | ||
| Yang, 2020 | Neurosurgery | Jan 23 to Mar 7 2020 | – | 55 | 0 | 55 | 0 | – | |||
| Zagra 2020 | Orthopedics | February 24th to April 10th, 2020 | Cancellation of elective surgeries | 823 | 664 | 268 | 2 | ||||
| Zhang 2020 | ENT | Jan 23 2020–April 6 2020 | – | – | – | – | – | – | |||
| Zhang, 2020 | Obstetrics | Jan to Feb 2020 | – | 61 | – | 61 | – | Neonatal bacterial pneumonia (n = 3/10) | – |