Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Br J Anaesth. 2020 Dec;125(6):895-911. doi: 10.1016/j.bja.2020.08.049. Epub 2020 Sep 4.
Current guidelines for perioperative management of coronavirus disease 19 (COVID-19) are mainly based on extrapolated evidence or expert opinion. We aimed to systematically investigate how COVID-19 affects perioperative management and clinical outcomes, to develop evidence-based guidelines.
First, we conducted a rapid literature review in EMBASE, MEDLINE, PubMed, Scopus, and Web of Science (January 1 to July 1, 2020), using a predefined protocol. Second, we performed a retrospective cohort analysis of 166 women undergoing Caesarean section at Tongji Hospital, Wuhan during the COVID-19 pandemic. Demographic, imaging, laboratory, and clinical data were obtained from electronic medical records.
The review identified 26 studies, mainly case reports/series. One large cohort reported greater mortality in elective surgery patients diagnosed after, rather than before surgery. Higher 30 day mortality was associated with emergency surgery, major surgery, poorer preoperative condition and surgery for malignancy. Regional anaesthesia was favoured in most studies and personal protective equipment (PPE) was generally used by healthcare workers (HCWs), but its use was poorly described for patients. In the retrospective cohort study, duration of surgery, oxygen therapy and hospital stay were longer in suspected or confirmed patients than negative patients, but there were no differences in neonatal outcomes. None of the 262 participating HCWs was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when using level 3 PPE perioperatively.
When COVID-19 is suspected, testing should be considered before non-urgent surgery. Until further evidence is available, HCWs should use level 3 PPE perioperatively for suspected or confirmed patients, but research is needed on its timing and specifications. Further research must examine longer-term outcomes.
CRD42020182891 (PROSPERO).
目前针对 2019 年冠状病毒病（COVID-19）围手术期管理的指南主要基于推断证据或专家意见。我们旨在系统地研究 COVID-19 如何影响围手术期管理和临床结局，以制定基于证据的指南。
首先，我们使用预设方案在 EMBASE、MEDLINE、PubMed、Scopus 和 Web of Science 上进行了快速文献综述（2020 年 1 月 1 日至 7 月 1 日）。其次，我们对在 COVID-19 大流行期间在武汉同济医院接受剖宫产的 166 名妇女进行了回顾性队列分析。从电子病历中获取人口统计学、影像学、实验室和临床数据。
综述确定了 26 项研究，主要是病例报告/系列。一项大型队列研究报告称，在手术后确诊而非手术前确诊的择期手术患者中，死亡率更高。较高的 30 天死亡率与急诊手术、大手术、较差的术前状况和恶性肿瘤手术有关。大多数研究中倾向于使用区域麻醉，医护人员（HCW）通常使用个人防护设备（PPE），但对患者的使用情况描述不佳。在回顾性队列研究中，疑似或确诊患者的手术持续时间、氧疗和住院时间长于阴性患者，但新生儿结局无差异。在围手术期使用 3 级 PPE 时，262 名参与的 HCW 中没有一人感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）。
当怀疑 COVID-19 时，应在非紧急手术前考虑进行检测。在有进一步证据之前，HCW 应在疑似或确诊患者围手术期使用 3 级 PPE，但需要研究其使用时机和规格。还必须研究更长期的结局。
CRD42020182891（PROSPERO）。
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