Wang Kun, Wu Changshuai, Xu Jian, Zhang Baohui, Zhang Xiaowang, Gao Zhenglian, Xia Zhengyuan
Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China.
Department of Anesthesiology, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
EClinicalMedicine. 2020 Dec;29:100612. doi: 10.1016/j.eclinm.2020.100612. Epub 2020 Nov 4.
The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking.
We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms "COVID-19″ or "SARS-CoV-2″ and "Surgery" or "Operation" for all published articles on COVID-19 from December 1, 2019 to October 5, 2020.
A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality ( = 0.891, < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality ( = 0.675, = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected.
COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE).
Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.
2019年新型冠状病毒病（COVID-19）可使围手术期过程复杂化，增加手术患者术后死亡率，对医务人员也是严重威胁。然而，缺乏总结COVID-19对患者围手术期死亡率及医务人员安全性影响的研究。
我们在PubMed、Cochrane图书馆、Embase及中国数据库中国知网（CNKI）中检索，检索词为“COVID-19”或“SARS-CoV-2”以及“外科手术”或“手术”，以查找2019年12月1日至2020年10月5日期间所有已发表的关于COVID-19的文章。
我们的荟萃分析共纳入了47项研究中的269例患者。COVID-19手术患者的平均年龄为50.91岁，49%为女性。共有28例患者死亡，总死亡率为6%。所有死亡患者均有与手术或COVID-19相关的术后并发症，包括呼吸衰竭、急性呼吸窘迫综合征（ARDS）、呼吸急促、呼吸困难、发热、咳嗽、疲劳或肌痛、心肺系统、休克/感染、急性肾损伤和严重淋巴细胞减少。术后出现任何一种或多种呼吸衰竭、ARDS、呼吸急促和呼吸困难症状的患者死亡率显著更高（比值比=0.891，P<0.001），而症状仅表现为发热、咳嗽、疲劳或肌痛的患者与术后死亡率仅呈边缘显著关联（比值比=0.675，P=0.023）。20项研究报告了医务人员感染信息，共有38名医务人员感染，使用生物安全3级（BSL-3）防护设备的医务人员未被感染。
COVID-19患者，尤其是有严重呼吸并发症的患者，术后死亡率可能较高。建议与感染患者密切接触的医务人员采取高级别的个人防护装备（PPE）。
黑龙江省博士后科研发展基金和中国国家自然科学基金。
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