Mortality of patients with COVID‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis

Background
There have been several reports that co‐infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2 at the time of surgery increases mortality. The aim of this study was to estimate the effect size of coronavirus disease 2019 (COVID‐19) on post‐operative mortality by performing a systematic review and meta‐analysis of the literature.

Methods
A systematic review and meta‐analysis of the literature was performed. A search was undertaken using electronic bibliographic databases MEDLINE, EMBASE, PubMed and Cochrane Library to identify eligible studies published from 1 November 2019 until 21 August 2020. Eligible papers for meta‐analysis were those that provided mortality rates following elective and emergency surgery in both COVID‐19 positive and negative patients. Forest plots and estimates of odds of death related to having COVID‐19 were formed using MedCalc version 9.6 software. Funnel plots to assess for publication bias and heterogeneity were formed in Meta‐Essentials.

Results
There were 140 records screened for inclusion. Full texts of 39 articles were reviewed, and 36 articles were included in the qualitative synthesis. There were eight studies eligible for meta‐analysis. There was a total of 193 operations performed on patients with a concurrent COVID‐19 infection and 910 performed on patients who were COVID‐19 negative. The odds ratio for mortality in patients who underwent a surgical procedure while COVID‐19 positive was 7.9 (95% confidence interval: 3.2–19.4).

Conclusion
This meta‐analysis confirms that concurrent COVID‐19 infection increases the risk of surgical mortality. The magnitude of this risk mandates that strategies are developed to mitigate the risk at both an individual and system level.