Delivering Urgent Elective Surgery at a COVID Clean Facility During Phase 1 of the UK Lockdown and Developing a Contingency Plan for Potential Future Waves

Abstract

Background: The COVID-19 pandemic has resulted in unprecedented disruption in the delivery of elective surgical care and fears of ongoing waves exist. Our organisation explored a model of care to enable safe delivery of urgent elective surgical care for the diagnosis of cancer across various specialties. This study presents the results of this model and the development of a contingency plan for a future wave of the COVID-19 pandemic. Methods: Early on during phase-1 of the UK lockdown, a clean facility fit for purpose for delivering elective surgical care was identified and measures implemented to ensure safety across the process. Results: A total of 499 patients were booked between 20/03/2020 to 18/06/2020 (Phase-1), 44 were cancelled because 7 developed symptoms of COVID-19 pre-operatively, household members of 2 patients became symptomatic, 4 failed to attend and 31 were unsuitable due to co-morbidities. There was no mortality at 7 or 30 days. Twenty two patients developed complications post-operatively, 4 required escalation of care, 5 required transfer to the parent site, 13 were readmitted and 4 required a re-operation. None of the patients developed COVID-19 in the post-operative period up to 30 days. Thirty-one patients developed symptoms suggestive of COVID-19 all of whom tested negative on a swab test. Overall, patient satisfaction was good. Conclusion: It was possible to safely deliver urgent elective surgical care at a COVID clean facility in our population. This strategy may facilitate the continued delivery of urgent elective surgical care during potential further waves of COVID-19 pandemic or similar future health crisis.