Abstract
AimDuring the COVID-19 pandemic, there has been worldwide cancellation of elective surgeries to protect patients from nosocomial viral transmission and peri-operative complications. With the unfolding situation, there is a definite need for an exit strategy to reinstate elective services. Therefore, more literature evidence supporting exit plans for elective surgical services is imperative to adopt a safe working principle. This study aims to provide evidence for safe elective surgical practice during the pandemic.MethodologyThis single centre, prospective, observational study included adult patients who were admitted and underwent elective surgical procedures in the trust’s COVID-free environment at the Birmingham Treatment Centre between May 19 and July 14, 2020. Data were collected on demographic parameters, peri-operative variables, surgical specialities, COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing results, post-operative complications and mortality. The study also highlighted the protocols it followed for the elective services during the pandemic.ResultsA total of 303 patients were included with mean age of 49.9 years (SD 16.5) comprising of 59% (178) female and 41% (125) male. They were classified according to the American Society of Anaesthesiologist Grade, different surgical specialities and types of anaesthesia used. Ninety-six percent (96%) of patients were discharged on the same day. Hundred percent (100%) compliance with pre-operative COVID-19 RT-PCR testing was maintained. There was no 30-day mortality or major respiratory complications.ConclusionCareful patient selection, simultaneous involvement of the pre-assessment and anaesthetic team, strict adherence to peri-operative protocols and delivering vigilant post-operative care for COVID-19 infection can help provide safe elective surgical services if the community transmission is under reasonable control. However, it is particularly important to maintain COVID-free safe environment for such procedures.
Highlights
World Health Organization declared COVID-19 infection as a pandemic on March 11, 2020 and soon it outspread to different continents quickly [1]
Patients undergoing surgery are susceptible to COVID-19 exposure in the hospital environment and could be vulnerable to further post-operative complications owing to immunosuppressive responses following surgery and pro-inflammatory cytokine surge [12,13]
We have reported on a prospective study involving adult elective surgeries performed in a COVID-19-free hospital environment during the COVID-19 pandemic
Summary
World Health Organization declared COVID-19 infection as a pandemic on March 11, 2020 and soon it outspread to different continents quickly [1] It was of particular concern for most of health care providers to be prepared to encounter a high number of critically sick patients [2,3,4,5]. There has been an extensive re-structuring of the human workforce during this critical hour resulting in the redeployment of theatre staff to more demanding specialities It led to a high number of pending elective surgeries. The COVIDSurg Collaborative Group estimated the total number of adult elective operations cancelled worldwide could be 28,404,603 during the 12-week peak (2,367,050 per week), accounting for over 2,000,000 cases per week [14] This clearly reflects the rolling-over pressure on the NHS. To cope with this situation, the National Health Service (NHS) England has adopted safe measures to resume
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