Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Nov 20, 2022; 12(6): 476-487
Published online Nov 20, 2022. doi: 10.5662/wjm.v12.i6.476
Associations between SARS-CoV-2 infections and thrombotic complications necessitating surgical intervention: A systematic review
Jennifer J Ferraro, Allie Reynolds, Sylvia Edoigiawerie, Michelle Y Seu, Sydney R Horen, Amir Aminzada, Alireza Hamidian Jahromi
Jennifer J Ferraro, Michelle Y Seu, Sydney R Horen, Amir Aminzada, Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
Allie Reynolds, Sylvia Edoigiawerie, Medical School, University of Chicago, Chicago, IL 60637, United States
Alireza Hamidian Jahromi, Department of Surgery, Temple University Hospital, Philadelphia, PA 19140, United States
Author contributions: Hamidian Jahromi A contributed to conceptualization and manuscript editing; Ferraro JJ, Reynolds A, Edoigiawerie S, Seu MY, Horen SR, and Aminzada A contributed to writing, statistical analysis, and manuscript editing.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alireza Hamidian Jahromi, MD, Assistant Professor, Doctor, Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Parkinson Pavilion, Suite 400, Philadelphia, PA 19140, United States. alirezahamidian@yahoo.com
Received: April 15, 2022
Peer-review started: April 15, 2022
First decision: August 1, 2022
Revised: September 1, 2022
Accepted: November 4, 2022
Article in press: November 4, 2022
Published online: November 20, 2022
Abstract
BACKGROUND

Several unique clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19) infection, have been identified and characterized. One such feature, mostly among patients with severe COVID-19 infection, has become known as COVID-19-induced coagulopathy. Surgical patients with a history of or active COVID-19 infection bear a significantly higher risk for postoperative thrombotic complications. These patients may require surgical intervention to treat severe thrombotic complications. Few studies have been carried out to better characterize this association. The purpose of this study was to perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. We hypothesized that patients with recent or active COVID-19 infection would have high rates of thromboembolic complications both arterial and venous in origin.

AIM

To perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention.

METHODS

The current systematic review implemented an algorithmic approach to review all the currently available English medical literature on surgical interventions necessitated by COVID-19 thrombotic complications using the preferred reporting items for systematic reviews and meta-analysis principles. A comprehensive search of the medical literature in the “PubMed”, “Scopus”, “Google Scholar” top 100 results, and archives of Plastic and Reconstructive Surgery was performed using the key words “COVID-19” AND “surgery” AND “thromboembolism” AND “complication”. The search string was generated and the records which were not specific about surgical interventions or thrombotic complications due to COVID-19 infection were excluded. Titles and abstracts were screened by two authors and full-text articles were assessed for eligibility and inclusion. Finally, results were further refined to focus on articles that focused on surgical interventions that were necessitated by COVID-19 thrombotic complications.

RESULTS

The database search resulted in the final inclusion of 22 retrospective studies, after application of the inclusion/exclusion criteria. Of the included studies, 17 were single case reports, 3 were case series and 2 were cross sectional cohort studies. All studies were retrospective in nature. Twelve of the reported studies were conducted in the United States of America, with the remaining studies originating from Italy, Turkey, Pakistan, France, Serbia, and Germany. All cases reported in our study were laboratory confirmed SARS-CoV-2 positive. A total of 70 cases involving surgical intervention were isolated from the 22 studies included in this review.

CONCLUSION

There is paucity of data describing the relationship between COVID-19 infection and thrombotic complications necessitating the need for surgical intervention. Intestinal ischemia and acute limb ischemia are amongst the most common thrombotic events due to COVID-19 that required operative management. An overall postoperative mortality of 30% was found in those who underwent operative procedures for thrombotic complications, with most deaths occurring in those with bowel ischemia. Physicians should be aware that despite thromboprophylaxis, severe thrombotic complications can still occur in this patient population, however, surgical intervention results in relatively low mortality apart from cases of ischemic bowel resection.

Keywords: Thromboembolic, COVID-19, SARS-CoV-2, Surgical intervention, Complications, Surgery

Core Tip: Surgical patient with a history of or current active infection with severe acute respiratory syndrome coronavirus 2 bear a significantly high risk for postoperative thrombotic complications. These patients may require surgical intervention to treat severe thrombotic complications. In total, 70 cases of thromboembolic complications necessitating surgical intervention have been documented. These patients have an overall mortality rate of 30%. Intestinal ischemia and acute limb ischemia are the most common thrombotic complications that required operative management. Physicians should be aware that severe thrombotic complications can occur in this patient population, however, surgical intervention results in relatively low mortality apart from cases of ischemic bowel resection.