Table 1.
Summary of selective publications on perioperative outcome after SARS-CoV-2 infection
| Authors | Title | Journal | Publication date | Country | Study design | Period of surgery | Sample size | Diagnosis/start of COVID-19 infection | Examined perioperative period (detection of SARS-CoV-2 infection) | Mortality | Most common complications | Recommendation distance from operation to SARS-CoV-2 infection | Some limitations |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lei et al. [8] | Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection | EClinicalMedicine (The Lancet) | April/2020 | China (Hubei province, Wuhan) | Retrospective cohort study | 01/2020–02/2020 | 34 | Onset of clinical symptoms | During the incubation period of COVID-19 infection | 20.5% (patients with perioperative COVID-19 infection), no comparison group | Pneumonia, ARDS, secondary infection | Preoperative quarantine period, exclusion of new COVID-19 infection | Small sample size, PCR tests preoperative not performed as standard |
| CovidSurg Collaborative [102] | Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study | The Lancet | May/2020 | international (24 countries, predominantly Europe and North America) | Retrospective cohort study | 01/2020–03/2020 | 1128 | PCR test or clinical suspicion or radiological signs | 7 days preoperative to 30 days postoperative | 30-day mortality rate: 23.8% (perioperative COVID-19 infection), 43.1% (emergency surgery, postoperative COVID-19 diagnosis, pulmonary complications), no comparison group | Pulmonary complications | Generous postponement of operations, balancing the consequences of postponed surgery and expected postoperative mortality with perioperative COVD-19 infection (risk factors: male and advanced age) | Not always PCR test used for diagnosis |
| Kahlberg et al. [103] | Vascular surgery during COVID-19 emergency in Hub Hospitals of Lombardy: experience on 305 patients | European Journal of Vascular & Endovascular Surgery | November/2020 | Italy (Lombardy) | Prospective study | 03/2020–04/2020 | 305 | PCR test and clinical suspicion with radiological signs | Pre- and postoperative | COVID vs non-COVID patient: In-hospital mortality: 25% vs 6%, Elective: 20.0% vs 2.8%, Emergent: 27.9% vs 13.2% | Multiorgan failure, respiratory failure | In surgical planning: consider COVID-19 infection as a negative prognostic factor (pulmonary and vascular complications) | Not always PCR test used for diagnosis |
| Mi et al. [104] | Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients | The Journal of Bone And Joint Surgery | May/2020 | China (Hubei province, Wuhan) | Retrospective cohort study | 01/2020–02/2020 | 10 | PCR test and/or radiological signs | COVID-19 infection before admission, postoperative | Of 2 patients with COVID-19 infection detected by PCR test and surgical treatment 1 died | Pulmonary complications | Surgical treatment should be carried out cautiously or non-operative care should be chosen | Very small sample size, not always PCR test used for diagnosis |
| COVIDSurg Collaborative [105] | Delaying surgery for patients with previous SARS-CoV-2 infection | British Journal of Surgery | November/2020 | International (16 countries, predominantly Italy, UK, Spain) | Prospective cohort study | 01/2020–03/2020 | 122 | PCR test | preoperative | 30-day mortality 3.4% (all patients with positive PCR test), 7.7% (1–2 weeks after positive PCR test), 3–4% (2–4 weeks after positive PCR test), 0% (> 4 weeks after positive PCR test), no comparison group | Pulmonary complications (10.7% COVID-19 infection vs 3.6% no COVID-19 infection) | Postponement of surgery > 4 weeks after positive PCR result | Small sample size |
| Doglietto et al. [106] | Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy | JAMA Surgery | June/2020 | Italy (Brescia) | Retrospective cohort study | 02/2020–04/2020 | 123 | PCR test and/or radiological signs (chest radiography and/or computed tomography) | Preoperative or within 1 week after surgery | COVID vs non-COVID patient: 30-day mortality: 19.51% vs 2.44% | Pulmonary and thrombotic complications | Postpone surgery if possible, because of increased mortality has been demonstrated | Not always PCR test used for diagnosis, single-center study |
| Catton et al. [107] | Planned surgery in the COVID-19 pandemic: a prospective cohort study from Nottingham | Langenbeck’ s Archives of Surgery | May/2021 | UK (Nottingham) | Prospective cohort study | 03/2020–04/2020 | 597 | PCR test confirmed suspected cases (temperature measurement and questionnaire or imaging) | 2 days preoperative to 30 days postoperative | 30-day mortality: 0.7% (all postoperative patients)vs 25% (postoperative patients with COVID-19 infection) | No information | Patient should be informed about increased mortality rate in COVID-19 infection after surgery. Urgent and cancer operations can take place with a low incidence of COVID-19 infection | Not always PCR test used for diagnosis, mortality not clearly attributable to COVID19 infection (e.g. palliative situation) small number of COVID-19 diagnosis or suspected COVID-19 infections (18 patients) |
| Jonker et al. [108] | Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications and thromboembolic events: a Dutch, multicenter, matched-cohort clinical study | Surgery | September/2020 | Netherlands | Retro- and prospective cohort study | 02/2020–06/2020 | 558 screened for the study, 503 included in data analysis | PCR test or clinical suspicion plus radiological signs (computed tomography of the chest) | 30 days before surgery or within 30 days postoperatively | COVID vs non-COVID patient: 30-day mortality: 12% vs 4% | Pulmonary and thromboembolic complications | Postponing elective surgeries and, if possible, emergency surgeries, altered protocols of thromboembolic prophylaxis | Not always PCR test used for diagnosis |
| COVIDSurg Collaborative & GlobalSurg Collaborative [109] | Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study | Anaesthesia | March/2021 | International (116 countries) | prospective cohort study | 10/2020 | 140 231 | PCR test or rapid antigen test or computed tomography of the chest or antibody test or clinical suspicion | Preoperative | 30-day mortality (weeks after COVID-19 diagnosis): 9.1% (0–2 weeks), 6.9% (3–4 weeks), 5.5% (5–6 weeks), 2% (> 7 weeks), 1.4% (no preoperative COVID-19 infection) | Pulmonary complications | Postpone surgery > 7 weeks after COVID-19 infection, longer for patients with persistent symptoms | Not always PCR test used for diagnosis |
| National emergency laparotomy audit [110] | The impact of COVID-19 on emergency laparotomy – an interim report of the national emergency laparotomy audit | Royal College of Anaesthetists | March/2021 | England and Wales | Retrospective cohort study | 03/2020–09/2020 | 10,546 | PCR test or clinical suspicion | Pre- and postoperative | COVID vs non-COVID patient: 30-day mortality: 12.5% vs 7.2% | No data | Due to increased postoperative mortality with COVID-19 infection, high-risk patients should be offered alternative/conservative therapies | Not always PCR test used for diagnosis |