key: cord-0759152-q67vbo0j
authors: Lawday, Samuel; Mills, Emily C.; Jones, Conor S.; Nepogodiev, Dmitri; Glasbey, James C.
title: Reply to: “Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis”
date: 2021-01-31
journal: EClinicalMedicine
DOI: 10.1016/j.eclinm.2020.100705
sha: f333a5ba9d3ae8671a4ccfefdf8ef1c74d9e9b4a
doc_id: 759152
cord_uid: q67vbo0j

nan

Reply to: "Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis" Samuel Lawday a , Emily C. Mills b , Conor S. Jones a, *, Dmitri Nepogodiev c , James C. Firstly, we are concerned about the inclusion and exclusion criteria. There was no PROSPERO pre-registration and the authors appear to have excluded cohort studies from their search criteria unjustifiably. This may explain why several large prospective and retrospective series have been missed by the authors; for example, just these three studies alone, [2À4] all published within the inclusion window have 6-times more patients than have been included in this metaanalysis. Furthermore, the inclusion of case studies and small caseseries in meta-analyses is strongly discouraged due to huge risks of publication bias as only 'cases of interest' are reported. [5] Secondly, the rate of postoperative mortality in SARS-CoV-2 infected patients seems inconsistent with higher quality reports which have been excluded from this meta-analysis (6% versus 23.8%)2.

Evidence has demonstrated that both 'COVID-19 free surgical pathways' and routine preoperative testing can mitigate additional risks posed during the pandemic. However, we fear that this study's conclusions may encourage surgeons to proceed without due caution.

The COVIDSurg collaborative has now collected prospective data on over 10,000 patients with perioperative SARS-CoV-2 infection. We welcome open collaboration with a transparent data sharing agreement to fill remaining research gaps (www.globalsurg.org/covid surg).

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: a systematic review and meta-analysis

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: a Dutch, multicenter, matched-cohort clinical study

Perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgical procedures

Cochrane handbook for systematic reviews of interventions version 6.1 (updated september 2020). Cochrane; 2020. Available from: www.training.cochrane.org/handbook