Global Prevalence of Perioperative Outcomes of Surgical Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract Background: Surgery during the COVID-19 pandemic is too challenging globally especially for low and middle-income countries in which the limping health care system is broken with low testing capacity, sub-optimal postoperative care, lack of anesthesia machine filters, and limited personal protective equipment. Body of evidence is lacking on the prevalence of perioperative outcomes of patients with COVID-19. Therefore, this study is aimed to provide the global prevalence of perioperative outcomes of patients with COVID-19.Methods: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 2019 to August 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting the prevalence of mortality were included.Results: A total of 515 articles were identified from different databases and 50 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The Meta-Analysis revealed that the global prevalence of perioperative mortality among COVID-19 patients was 20% (95% CI: 15 to 26). The Meta-Analysis also revealed that the rate of postoperative ICU admission was 15% (95% confidence interval (CI):10 to 21).Conclusion: There is one death for every five COVID-19 patients undergoing surgical procedures which entails mitigating strategies to decrease perioperative mortality, provide less risky anesthetic techniques, and alternative management other than surgical procedures.Registration: This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.

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Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Global Health ◽

10.1136/bmjgh-2018-000810 ◽

2018 ◽

Vol 3 (3) ◽

pp. e000810 ◽

Cited By ~ 19

Author(s):

Joshua S Ng-Kamstra ◽

Sumedha Arya ◽

Sarah L M Greenberg ◽

Meera Kotagal ◽

Catherine Arsenault ◽

...

Keyword(s):

Systematic Review ◽

Surgical Procedures ◽

Low Income ◽

Meta Analysis ◽

Surgical Care ◽

Low Income Countries ◽

Perioperative Mortality ◽

Middle Income ◽

Middle Income Countries ◽

Wide Range

IntroductionThe Lancet Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs. We also describe how POMR is defined and reported in the LMIC literature to provide recommendations for future monitoring in resource-constrained settings.MethodsWe did a systematic review of studies from LMICs published from 2009 to 2014 reporting POMR for any surgical procedure. We extracted select variables in duplicate from each included study and pooled estimates of POMR by type of procedure using random-effects meta-analysis of proportions and the Freeman-Tukey double arcsine transformation to stabilise variances.ResultsWe included 985 studies conducted across 83 LMICs, covering 191 types of surgical procedures performed on 1 020 869 patients. Pooled POMR ranged from less than 0.1% for appendectomy, cholecystectomy and caesarean delivery to 20%–27% for typhoid intestinal perforation, intracranial haemorrhage and operative head injury. We found no consistent associations between procedure-specific POMR and Human Development Index (HDI) or income-group apart from emergency peripartum hysterectomy POMR, which appeared higher in low-income countries. Inpatient mortality was the most commonly used definition, though only 46.2% of studies explicitly defined the time frame during which deaths accrued.ConclusionsEfforts to improve access to surgical care in LMICs should be accompanied by investment in improving the quality and safety of care. To improve the usefulness of POMR as a safety benchmark, standard reporting items should be included with any POMR estimate. Choosing a basket of procedures for which POMR is tracked may offer institutions and countries the standardisation required to meaningfully compare surgical outcomes across contexts and improve population health outcomes.

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An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

Journal of Neurosurgery ◽

10.3171/2018.3.jns171722 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1127-1141 ◽

Cited By ~ 4

Author(s):

Kerry A. Vaughan ◽

Christian Lopez Ramos ◽

Vivek P. Buch ◽

Rania A. Mekary ◽

Julia R. Amundson ◽

...

Keyword(s):

Systematic Review ◽

Latin America ◽

Meta Analysis ◽

Healthcare Resources ◽

Middle Income ◽

Income Levels ◽

Global Prevalence ◽

Middle Income Countries ◽

Active Epilepsy ◽

Low And Middle Income

OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.

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Perioperative Mortality Rates: A Systematic Review and Meta-Analysis of the Literature from Low- and Middle-Income Countries

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.236 ◽

2017 ◽

Vol 225 (4) ◽

pp. S107

Author(s):

Joshua Ng-Kamstra ◽

Sumedha Arya ◽

Sarah L. Greenberg ◽

Meera Kotagal ◽

John G. Meara ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Mortality Rates ◽

Perioperative Mortality ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

10.31234/osf.io/mg5s4 ◽

2018 ◽

Author(s):

Joao Ricardo Nickenig Vissoci

Keyword(s):

Systematic Review ◽

Alcohol Use ◽

Randomized Controlled Trials ◽

Brain Stimulation ◽

Meta Analysis ◽

World Health ◽

Controlled Trials ◽

Middle Income ◽

Brief Motivational Intervention ◽

Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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