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The 'hub' model for colorectal surgery: a viable paradigm shift?
P Janardhanan1, A Khalid1, M H Anwaar1
1University Hospitals Birmingham NHS Foundation Trust, UK.
Introduction:
Nationally, in the aftermath of the first COVID-19 lockdown, the waiting list for elective surgery is approximately 7 million. To ameliorate an evolving crisis and improve system resilience, the Royal College of Surgeons of England proposed a 'New Deal for Surgery', promoting COVID-light sites and elective hubs. We evaluate the short-term outcomes, safety and sustainability of the hub model at a large National Health Service trust.
Methods:
All major elective colorectal operations performed at the hub between 8 March 2021 and 8 March 2022 were included for analysis. Pertinent data on patient demographics, operative performance and postoperative outcomes were analysed using SPSS 27.
Results:
In total, 401 cases were analysed. There was one same-day cancellation because of the unavailability of beds (0.2%). Median distance displacement for patients for their primary surgery was +3.2 miles. Twenty-one patients (5.2%) required postoperative blood transfusion. One patient had nosocomial COVID-19 (0.2%), severe complications of Clavien-Dindo grade ≥3 were observed in 33 patient (8.2%) and transfer-out for higher level care occurred in 34 cases (8.5%). Forty-six 30-day readmissions (11.5%) and two deaths (0.4%) were noted. Median length of stay was 6 days.
Conclusions:
The volume of major colorectal surgery at the hub, with acceptable incidence of major complication, transfer-out and minimal patient displacement, attests to the efficacy and safety of the new model.
