30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway
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Insights
Elective surgery is safe during the COVID-19 pandemic. A preoperative screening protocol for SARS-CoV-2 significantly reduced postoperative COVID-19 infection rates in patients undergoing major operations.
Area of Science:
- Medical Research
- Infectious Disease Epidemiology
- Surgical Outcomes
Background:
- The COVID-19 pandemic led to increased postoperative complications and mortality, causing widespread elective surgery cancellations in the UK.
- An elective operating framework was established at London Bridge Hospital (LBH), a COVID-19 minimal site, to mitigate these risks.
- The framework required patients to self-isolate preoperatively and undergo SARS-CoV-2 testing.
Purpose of the Study:
- To evaluate the incidence of postoperative COVID-19 infection within a dedicated elective surgical framework.
- To assess the safety and feasibility of conducting high-volume elective surgery during the COVID-19 pandemic.
Main Methods:
- A collaborative study involving three major hospital trusts in south-east London.
- 398 patients undergoing elective surgery at LBH were included.
- Patients were followed up via telephone for four weeks postoperatively.
Main Results:
- The study included 398 patients across 13 surgical specialties, with a median age of 60 years.
- 83.6% of operations were classified as 'major'.
- The rate of COVID-19-related death was 0.25% (1/398), and the 30-day all-cause mortality rate was 1.26% (5/398). Seven patients (1.76%) reported COVID-19 symptoms, with no emergency department visits or readmissions.
Conclusions:
- The implemented elective operating framework demonstrated a very low risk of postoperative COVID-19 infection.
- High-volume major surgery can be performed safely, even during the pandemic peak, with appropriate preoperative screening for SARS-CoV-2.
Introduction:
Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection.
Methods:
The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively.
Results:
Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result.
Conclusion:
The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.
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