Abstract
PurposeGlobally planned surgical procedures have been deferred during the current COVID-19 pandemic. The study aimed to report the outcomes of planned urgent and cancer cases during the current pandemic using a multi-disciplinary prioritisation group.MethodsA prospective cohort study of patients having urgent or cancer surgery at a NHS Trust from 1st March to 30th April 2020 who had been prioritised by a multi-disciplinary COVID Surgery group. Rates of post-operative PCR positive and suspected COVID-19 infections within 30 days, 30-day mortality and any death related to COVID-19 are reported.ResultsOverall 597 patients underwent surgery with a median age of 65 years (interquartile range (IQR) 54–74 years). Of these, 86.1% (514/597) had a current cancer diagnosis. During the period, 60.8% (363/597) of patients had surgery at the NHS Trust whilst 39.2% (234/597) had surgery at Independent Sector hospitals. The incidence of COVID-19 in the East Midlands was 193.7 per 100,000 population during the study period. In the 30 days following surgery, 1.3% (8/597) of patients tested positive for COVID-19 with all cases at the NHS site. Overall 30-day mortality was 0.7% (4/597). Following a PCR positive COVID-19 diagnosis, mortality was 25.0% (2/8). Including both PCR positive and suspected cases, 3.0% (18/597) developed COVID-19 infection with 1.3% at the independent site compared to 4.1% at the NHS Trust (p=0.047).ConclusionsRates of COVID-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.
Highlights
It is estimated over 28 million operations will be deferred globally during the COVID-19 pandemic peak [1]
Nottingham University Hospitals (NUH) NHS Trust is a large teaching hospital which normally serves as a tertiary referral centre and trauma centre
All cancer related and perioperative pathway specialties were co-opted into the prioritisation group including breast, colorectal, hepatobiliary, endocrine, gynaecology, head and neck, neurosurgery, plastics, thoracic, upper gastrointestinal surgery and urology, with additional support from microbiology/infectious diseases consultants, administrators and ethics representatives for the Trust
Summary
It is estimated over 28 million operations will be deferred globally during the COVID-19 pandemic peak [1]. International and National guidance on the management of patients in the perioperative period has changed during the course of the pandemic in response to emerging evidence, but it remains extremely limited in many areas of clinical concern [3,4,5]. Patients requiring urgent and cancer care were advised surgery would be undertaken but might be delayed depending on the local infection rate and COVID-19 burden on services. This was set against the potential risk of harm due to delays in cancer surgery [7]
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