Factors Affecting the Mortality of Patients with COVID-19 Undergoing Surgery and the Safety of Surgical Team: A Systematic Review (preprint)

Background: COVID-19 can complicate the perioperative course to increase postoperative mortality in infected patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of surgical team are lacking.Methods: We searched PubMed, Cochrane Library, Embase and a Chinese database with the search terms “COVID-19” or “SARS-CoV-2” and “Surgery” or “Operation” for all published articles on COVID-19 since the outbreak. The search was finalized on May 29th, 2020.Findings: A total of 255 patients from 36 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.03 years, and 56% were female. A total of 27 patients were deceased, with an overall mortality of 7%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure/ARDS/short of breath/dyspnea, fever/cough/fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. While only respiratory failure/ARDS/short of breath/dyspnea after operation was associated with significantly higher mortality (r=0.879, p =0.001), while fever/cough/fatigue or myalgia demonstrated marginally significant association with mortality (r=0.619, p =0.056). 13 of the 36 studies reported medical staff infection and levels of personal protection, and a total of 38 medical staff were infected. Of note, none of the staffs with PPE 3 was infected.Interpretation: COVID-19 patients, in particular whose with severe respiratory complications, may have high postoperative mortality. And, medical staff in close contact with infected patients are suggested to take high level PPE.Funding Statement: This work was supported by Heilongjiang postdoctoral scientific research developmental fund (LBH-Q17127); Youth Elite Training Foundation (JY2015-05) of Harbin Medical University Cancer Hospital, and the National Natural Science Foundation of China (NO. 81970247, and NO. 81670770).Declaration of Interests: None.

The Outcome Impact of Early vs Late HFNC Oxygen Therapy in Elderly Patients with COVID-19 and ARDS (preprint)

Coronavirus disease-2019 (COVID-19) has rapidly spread worldwide. High-flow nasal cannula therapy (HFNC) is a major oxygen supporting therapy for severely ill patients, but information regarding the timing of HFNC application is scarce, especially in elderly patients. We retrospectively analyzed the clinical data of 110 elderly patients ([≥]65 years) who received HFNC from Renmin Hospital of Wuhan University, People's Hospital of Xiantao City and Chinese Medicine Hospital of Shishou City in Hubei Province, China, and from Affiliated Hospital of Guangdong Medical University, People's Hospital of Yangjiang City, People's Hospital of Maoming City in Guangdong Province, China. Of the 110 patients, the median age was 71 years (IQR, 68-78) and 59.1% was male. Thirty-eight patients received HFNC when 200 mmHg < PO2/FiO2 [≤] 300 mmHg (early HFNC group), and 72 patients received HFNC treatment when 100 mmHg < PaO2/FiO2 [≤] 200 mmHg (late HFNC group). Compared with the late HFNC group, patients in the early HFNC group had a lower likelihood of developing severe ARDS, longer time from illness onset to severe ARDS and shorter duration of viral shedding after illness onset, as well as shorter lengths of ICU and hospital stay. Twenty-four patients died during hospitalization, of whom 22 deaths (30.6%) were in the late HFNC group and 2(5.3%) in the early HFNC group. It is concluded that the prognosis was better in severely ill elderly patients with COVID-19 receiving early compared to late HFNC. This suggests HFNC could be considered early in this disease process.

COVID-19: Repeated video-watching vs. combined video-watching and live demonstration as training to health care providers for donning and doffing personal protective equipment (preprint)

Background During the COVID-19 pandemic, not only was there a lack of personal protective equipment (PPE) for health care workers but a dearth in training in respect of its donning and doffing. This study compared two training methods for donning and doffing PPE in order to teach health care workers how to do so more effectively and quickly.Method A total of 48 health care workers were recruited and randomly divided into two groups. Group A watched a 10-minute demonstration (demo) video repeated four times, while Group B watched the same demo video twice followed by a 10-minute live demo twice. The learning time of both groups was the same, and an examination was performed immediately after the completion of training. The examination scores of Group A and Group B were recorded according to the checklist (Appendix 1). The time taken for the participants to don and doff PPE, their satisfaction with the training, and the confidence to don and doff PPE were analyzed.Results The average score of Group B was better than that of Group A, with a mean (SD) of 94.92 (1.72) vs. 86.63 (6.34), respectively (P < 0.001). The average time spent by Group B to do the examination was shorter than that of Group A, with a mean (SD) of 17.67 (1.01) vs. 21.75 (1.82), respectively (P < 0.001). The satisfaction and confidence of Group B were higher than those of group A (P < 0.001).Conclusions Compared with repeated video-watching learning, the video-watching plus a live demonstration teaching method is more suitable for health care workers to learn how to put on and remove personal protective equipment.