James C Glasbey1, Dmitri Nepogodiev1, Joana F F Simoes1, Omar Omar1, Elizabeth Li2, Mary L Venn3, Mohammad K Abou Chaar4, Vita Capizzi5, Daoud Chaudhry2, Anant Desai6, Jonathan G Edwards7, Jonathan P Evans8, Marco Fiore5, Jose Flavio Videria9, Samuel J Ford6, Ian Ganly10, Ewen A Griffiths11, Rohan R Gujjuri2, Angelos G Kolias12, Haytham M A Kaafarani13, Ana Minaya-Bravo14, Siobhan C McKay15, Helen M Mohan16, Keith J Roberts15, Carlos San Miguel-Méndez14, Peter Pockney17, Richard Shaw18, Neil J Smart19, Grant D Stewart20, Sudha Sundar Mrcog21, Raghavan Vidya22, Aneel A Bhangu2. 1. NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom. 2. University of Birmingham, Birmingham, United Kingdom. 3. Queen Mary University of London, London, United Kingdom. 4. King Hussein Cancer Foundation: King Hussein Cancer Center, Amman, Jordan. 5. Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 6. Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 7. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. 8. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 9. Francisco Gentil Portuguese Institute for Oncology of Porto: Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal. 10. Memorial Sloan Kettering Cancer Center, New York, NY. 11. Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 12. Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom. 13. Harvard Medical School, Centre for Outcomes & Patient Safety in Surgery, Boston, MA. 14. Henares University Hospital: Hospital Universitario del Henares, Madrid, Spain. 15. Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 16. St. James Hospital, Dublin, Ireland. 17. University of Newcastle, NSW, Australia. 18. Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom. 19. Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. 20. University of Cambridge, Cambridge, United Kingdom. 21. Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, United Kingdom. 22. Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom.
Abstract
PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Rupert M Pearse; Tom E Abbott; Richard Haslop; Tahania Ahmad; Brennan C Kahan; Claudia Filipini; Andrew Rhodes; Marco Ranieri Journal: Minerva Anestesiol Date: 2016-10-20 Impact factor: 3.051
Authors: Matthew M Kavanagh; Ngozi A Erondu; Oyewale Tomori; Victor J Dzau; Emelda A Okiro; Allan Maleche; Ifeyinwa C Aniebo; Umunya Rugege; Charles B Holmes; Lawrence O Gostin Journal: Lancet Date: 2020-05-07 Impact factor: 79.321
Authors: Vikas Mehta; Sanjay Goel; Rafi Kabarriti; Balazs Halmos; Amit Verma; Daniel Cole; Mendel Goldfinger; Ana Acuna-Villaorduna; Kith Pradhan; Raja Thota; Stan Reissman; Joseph A Sparano; Benjamin A Gartrell; Richard V Smith; Nitin Ohri; Madhur Garg; Andrew D Racine; Shalom Kalnicki; Roman Perez-Soler Journal: Cancer Discov Date: 2020-05-01 Impact factor: 38.272
Authors: Kamal S Saini; Begoña de Las Heras; Javier de Castro; Ramachandran Venkitaraman; Martine Poelman; Gopalakrishnan Srinivasan; Monika Lamba Saini; Sanjeev Verma; Manuela Leone; Philippe Aftimos; Giuseppe Curigliano Journal: Lancet Haematol Date: 2020-04-24 Impact factor: 18.959
Authors: Thomas Round; Veline L'Esperance; Joanne Bayly; Kate Brain; Lorraine Dallas; John G Edwards; Thomas Haswell; Crispin Hiley; Natasha Lovell; Julia McAdam; Grace McCutchan; Arjun Nair; Thomas Newsom-Davis; Elizabeth K Sage; Neal Navani Journal: Br J Cancer Date: 2021-05-10 Impact factor: 7.640
Authors: Teele Kuusk; David Cullen; Joana Briosa Neves; Nicholas Campain; Ravi Barod; Ekaterini Boleti; Soha El-Sheihk; Lee Grant; John Kelly; Marta Marchetti; Faiz Mumtaz; Prasad Patki; Navin Ramachandran; Pedro Silva; My-Anh Tran-Dang; Miles Walkden; Maxine G B Tran; Thomas Powles; Axel Bex Journal: BJU Int Date: 2021-05-25 Impact factor: 5.969
Authors: Jemma M Boyle; Angela Kuryba; Helen A Blake; Ajay Aggarwal; Jan van der Meulen; Kate Walker; Michael Braun; Nicola Fearnhead Journal: Colorectal Dis Date: 2021-04-08 Impact factor: 3.917
Authors: L Scappaticcio; M I Maiorino; S Iorio; C Camponovo; A Piccardo; G Bellastella; G Docimo; K Esposito; P Trimboli Journal: J Endocrinol Invest Date: 2021-07-19 Impact factor: 4.256
Authors: Daniel P Dolan; Scott J Swanson; Daniel N Lee; Emily Polhemus; Suden Kucukak; Daniel C Wiener; Raphael Bueno; Jon O Wee; Abby White Journal: Semin Thorac Cardiovasc Surg Date: 2021-07-01
Authors: Angela Kuryba; Jemma M Boyle; Helen A Blake; Ajay Aggarwal; Jan van der Meulen; Michael Braun; Kate Walker; Nicola S Fearnhead Journal: Ann Surg Open Date: 2021-06-10