In a recent study published on the preprint server medRxiv,* scientists compare post-surgical complications before and during the coronavirus disease 2019 (COVID-19) pandemic. The findings from this study demonstrate higher rates of post-surgical mortality during the pandemic, despite no difference in the incidence of surgical complications between the pre-COVID and post-COVID eras.
Study: The comparison of Post-Operative Complications pre Covid era versus during Covid-Era based on Clavien-Dindo-classification: A Systematic Review and Meta-Analysis. Image Credit: Gerain0812 / Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Background
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused severe damage to the global healthcare system. An overwhelming hospital occupancy, coupled with the extensive use of medical resources, has resulted in significant deprivation in routine medical care and prolonged delays in crucial surgeries.
With the deployment of preventive vaccines, a gradual improvement in pandemic situations has been observed worldwide. Many hospitals and healthcare institutions have started resuming long-pending surgeries. However, it remains uncertain whether performing surgeries during the pandemic is beneficial or detrimental for patients who are still at risk of acquiring SARS-CoV-2 infection from hospital setups.
In the current systematic review and meta-analysis, the scientists aim to compare post-surgical complications in patients who underwent surgeries before and during the COVID-19 pandemic.
About the study
The analysis included studies related to post-surgical complications that were published between January 2019 and November 2021. The focus was primarily on three types of surgeries including urgent, emergent, and elective surgeries. A total of 909 studies were screened, 34 of which were selected for the systematic review, and 11 were selected for the meta-analysis.
The Clavien-Dindo classification system was used to categorize post-surgical complications into five grades. Grade 1 denotes any deviation from the normal recovery that does not require specific treatments, whereas grade 2 denotes the requirement of specific treatments during recovery.
Grade 3 denotes the requirement of surgical, radiologic, and endoscopic interventions during recovery. Grade 4 denotes the emergence of life-threatening complications during recovery that require intensive care, whereas grade 5 denotes death of the patient during recovery.
Study findings
The data obtained from more than 19,000 patients were included in the meta-analysis. The most common type of surgery was elective surgery, followed by urgent, emergent, and expediated surgeries. The most commonly reported surgeries were non-vascular abdominal surgeries, urologic/gynecologic surgeries, and cardiothoracic surgeries.
Of all patients analyzed, 3,522 were surgically operated on before the pandemic, and 15,615 were operated on during the pandemic. No significant difference in post-surgical complications was reported between the pre-pandemic and during-pandemic eras; however, a significantly higher post-surgical mortality was observed during the pandemic compared to that before the pandemic.
Conclusions
The current study highlights that the risk of surgery-related complications is comparable between pre-pandemic and during-pandemic eras. This indicates that routine surgical procedures can be continued during the pandemic with proper implementation of COVID-appropriate control measures and protocols.
Notably, high surgery-related mortality observed during the pandemic could be due to a delay in treatment, more advanced disease stage, or more complicated patient selection for surgery.
As observed in the systematic review, many preventive measures, including self-isolation, staff and patient screening for COVID-19, and mask-wearing in the operation room, have been applied in an attempt to reduce surgery-related complications. Additionally, several new guidelines, recommendations, and surgical techniques have been implemented, including patient prioritization, intensive care unit (ICU) preserving techniques, use of robotic surgery, and distant monitoring and follow-up of patients. These measures have collectively helped to reduce the risk of post-surgical complications during the pandemic.
A majority of studies included in the current meta-analysis were from developed countries. Thus, more studies from socio-economically underprivileged countries should be analyzed to better understand the impact of pandemic-imposed shortages in medical resources and infrastructures on post-surgical complications.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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