Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study

Hua Zheng, Harry L. Hébert, Athanasia Chatziperi, Weihua Meng, Blair H. Smith, Jing Yan, Zhiqiang Zhou, Xianwei Zhang, Ailin Luo, Liuming Wang, Wentao Zhu, Junbo Hu (Lead / Corresponding author), Lesley A. Colvin (Lead / Corresponding author)

Research output: Contribution to journalReview articlepeer-review

16 Citations (Scopus)
50 Downloads (Pure)


Background: Current guidelines for perioperative management of coronavirus disease 19 (COVID-19) are mainly based on extrapolated evidence or expert opinion. We aimed to systematically investigate how COVID-19 affects perioperative management and clinical outcomes, to develop evidence-based guidelines.

Methods: First, we conducted a rapid literature review in EMBASE, MEDLINE, PubMed, Scopus, and Web of Science (January 1 to July 1, 2020), using a predefined protocol. Second, we performed a retrospective cohort analysis of 166 women undergoing Caesarean section at Tongji Hospital, Wuhan during the COVID-19 pandemic. Demographic, imaging, laboratory, and clinical data were obtained from electronic medical records.

Results: The review identified 26 studies, mainly case reports/series. One large cohort reported greater mortality in elective surgery patients diagnosed after, rather than before surgery. Higher 30 day mortality was associated with emergency surgery, major surgery, poorer preoperative condition and surgery for malignancy. Regional anaesthesia was favoured in most studies and personal protective equipment (PPE) was generally used by healthcare workers (HCWs), but its use was poorly described for patients. In the retrospective cohort study, duration of surgery, oxygen therapy and hospital stay were longer in suspected or confirmed patients than negative patients, but there were no differences in neonatal outcomes. None of the 262 participating HCWs was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when using level 3 PPE perioperatively.

Conclusions: When COVID-19 is suspected, testing should be considered before non-urgent surgery. Until further evidence is available, HCWs should use level 3 PPE perioperatively for suspected or confirmed patients, but research is needed on its timing and specifications. Further research must examine longer-term outcomes.

Clinical trial registration: CRD42020182891 (PROSPERO).

Original languageEnglish
Pages (from-to)895-911
Number of pages17
JournalBritish Journal of Anaesthesia
Issue number6
Early online date4 Sept 2020
Publication statusPublished - Dec 2020


  • Caesarean delivery
  • COVID-19
  • perioperative outcome
  • personal protective equipment
  • SARS-CoV-2 testing

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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