A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

Background

Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems.

Methods

During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network.

The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days.

Results

500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19.

Conclusion

It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration.

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Priority surgeries are being cancelled every week due to the COVID-19 pandemic.

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A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery

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The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’.

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After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19.

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It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.

Single centre concept of 'cold site' elective surgery during the peak of COVID-19 pandemic : A cohort study

Objective

The COVID-19 pandemic caused a major strain on healthcare systems across the globe. As these systems got overwhelmed with the emergency care of the infected patients, widespread cancellations of elective surgery occurred. Our hospital utilised local private hospital as a dedicated cold site (CS) for urgent elective surgery during the peak of the COVID-19 pandemic. We aim to analyse the outcomes at this dedicated cold site.

Method

A retrospective review of a prospectively maintained database of all the cases operated at the CS during a 2-month period (30 March 2020 to 29 May 2020) was carried out. The primary outcome was 30-day COVID-19 related mortality. The secondary outcomes were 30-day non-COVID-19 related mortality, complications, readmission and development of COVID-19 symptoms.

Results

A total of 153 patients were operated at the CS over the study period with a median age of 57 years (Interquartile range, IQR 47-70). 62% were females and 82% had a Body Mass Index (BMI) less than 30. 73% of the operations were performed for cancer. 59% of the surgeries were graded as intermediate and 26% as major or complex. There was no mortality at 30 days from COVID-19 or non COVID-19 causes. There was only 1 (0.65%) readmission. 7 patients (4.57%) developed complications. 1 (0.65%) patient was diagnosed with COVID-19 in the postoperative period while 3 had COVID-19 symptoms but were tested negative.

Conclusion

Urgent elective surgery is safe and feasible during the COVID-19 pandemic if a dedicated cold site is available.