Analysis of worldwide surgical outcomes in COVID-19-infected patients: A gynecological oncology perspective

Abstract

Coronavirus Disease 2019 (COVID-19) guidance limits all but the most urgent surgery in the United Kingdom. We review the literature and our experience in gynecology to assess perioperative outcomes. PubMed was searched with (surg*[Title])AND(COVID[Title]), (surg*[Title])AND(2019-nCoV[Title]), and (surg*[Title])AND(SARS-CoV-2[Title]), and 67 COVID-19-positive surgical patients across ten hospitals in four countries are included. Median mortality was 33%. Cardiac and pulmonary co-morbidities associated with higher risk of COVID-19-positive postoperative death. Mortality was high in neurosurgery (80%) and the lowest in gynecological oncology surgery (none). This analysis provides an evidence base on which to consider surgical risk assessment for different specialties. Risk of perioperative death needs to be assessed in the context of patients' co-morbidities and surgical specialty. An individualized approach toward surgical decision making is imperative. Lay abstract Coronavirus Disease 2019 (COVID-19) has resulted in cancer patients receiving inferior surgical treatment compared with normal treatment plans. The risk of death after surgery, when infected with COVID-19, can be as high as 33%. For this reason, during the pandemic, guidelines were issued to protect healthcare services by prohibiting all but the most urgent surgery. This article shows that death rates vary by surgical specialty. The risk of dying within 30 days of surgery is particularly low in gynecological oncology patients. Guidelines should be tailored toward individuals' needs rather than applying a blanket approach to all.