Association of COVID-19 and Mortality in Surgical Populations by Surgery Types: A Systematic Review and Meta-Analysis

Introduction: Since the start of the COVID-19 pandemic thousands of operations have been canceled or postponed in patients with COVID-19. To date no systematic review or meta-analysis has comprehensively estimated the risk of mortality from surgery by surgery type. We aim to delineate the risk of mortality in patients with COVID-19 based on surgery type. Methods: PubMed (MEDLINE), Scopus, OVID the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. A total of 4023 studies were identified from databases and through cited references. Studies providing data on mortality in patients undergoing surgery was included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was Mortality in Patients with COVID-19. Results: From a total of 4,023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 years, 57% were male. Surgery types included general surgery (14.9%), orthopaedic surgery (23.4%), vascular (6.4%), thoracic (10.6%), urological (8.5%). Patients undergoing surgery with COVID-19 elicited a 9 -fold increased risk of mortality (odds ratio [OR]: 8.99, 95% CI 4.96- 16.32) over those without COVID-19. Urologic surgeries presented the highest risk of mortality (OR:21.62 95% CI 4.53-103.11), orthopaedic and vascular surgery types also had high rates of mortality. General surgery reported the lowest rate of mortality in patients with COVID-19 (OR 3.84, 95% CI 1.92-7.68). Conclusion: Mortality risk in surgical patients with COVID-19 is operation-type specific.