Evaluation of 30-day mortality for 500 patients undergoing non-emergency surgery in a COVID-19 cold site within a multicentre regional surgical network during the COVID-19 pandemic

Kasivisvanathan,; Lindsay, Jamie; Rakshani-Moghadam, Sara; Elhamshary, A; Kapriniotis, Konstantinos; G, Kazantzis; Syed, Bilal; Hines, Jonas Z; Bex, A.; Dh, Ho; Hayward, Martin; Bhan, Chetan; MacDonald, Nicola; Clarke, S.; Walker, David; Bellingan, Geoff; Moore, Jaclyn; Rohn, Jennifer; Muneer, Asıf; Roberts, Lois; Haddad, Fares S.; Jd, Kelly

doi:10.1101/2020.06.10.20115543

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…(9) The ‘cold’ site model has been safely described elsewhere, and reports from another ‘cold’ site in London have reported a 2% rate of post-operative COVID-19 infection, with only 0.2% of their cohort reporting Clavien-Dindo grade 3 complications related to COVID-19. (10) The current study supports the practice of ‘cold’ sites in areas still suffering from high rates of COVID-19.…”

Section: Discussionsupporting

confidence: 78%

Safety of ‘hot’ and ‘cold’ site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic

Stroman

Russell

Kotecha

et al. 2020

Preprint

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Importance: Contracting COVID-19 peri-operatively has been associated with a mortality rate as high as 23%. Using hot and cold sites has led to a low rate of post-operative diagnosis of COVID-19 infection and allowed safe continuation of important emergency and cancer operations in our centre. Objective: The primary objective was to determine the safety of the continuation of surgical admissions and procedures during the height of the COVID-19 pandemic using hot and cold surgical sites. The secondary objective is to determine risk factors of contracting COVID-19 to help guide further prevention. Setting: A single surgical department at a tertiary care referral centre in London, United Kingdom. Participants: All consecutive patients admitted under the care of the urology team over a 3-month period from 1st March to 31st May 2020 over both hot acute admission sites and cold elective sites were included. Exposures: COVID-19 was prevalent in the community over the three months of the study at the height of the pandemic. The majority of elective surgery was carried out in a cold site requiring patients to have a negative COVID-19 swab 72 hours prior to admission and to self-isolate for 14 days pre-operatively, whilst all acute admissions were admitted to the hot site. Main outcomes and measures: COVID-19 was detected in 1.6% of post-operative patients. There was 1 (0.2%) post-operative mortality due to COVID-19. Results: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the surgical team. Of these, 101 (16.5%) were admitted on the cold site and 510 (83.5%) on the hot site. Surgical procedures were performed in 495 patients of which 8 (1.6%) contracted COVID-19 post-operatively with 1 (0.2%) post-operative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with 2 (0.3%) deaths. On multivariate analysis, length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Conclusions and Relevance: Continuation of surgical procedures using hot and cold sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a post-operative mortality. Reducing length of stay may be able to reduce contraction of COVID-19.

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Section: Discussionsupporting

confidence: 78%

Safety of ‘hot’ and ‘cold’ site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic

Stroman

Russell

Kotecha

et al. 2020

Preprint

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“…It would provide enhanced system resilience in the context of future COVID-19 outbreaks to continue planned surgery in dedicated clean sites. 8 26 27 The scheme may have additional benefits including increased patient choice, greater workforce flexibility and maximisation of teams across areas, with increasing efficiency. There is a paucity of high-quality data on the effects of pooled waiting-lists.…”

Section: Discussionmentioning

confidence: 99%

New geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study

et al. 2020

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ObjectivesThe suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers.DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England.ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018.Main outcome measuresThe identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.

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“…Another study that assessed the feasibility of nonemergency surgery in a COVID-19 cold site during the pandemic demonstrated that out of 500 patients only 10 (2%) had COVID-19 infection post-operatively. 14 Three patients (1%) passed away within 30 days of surgery; however, no mortality was noted due to COVID-19 infection. Grade 3 or more Clavien-Dindo complications were recorded in 33 patients (7%) overall and in only one patient (3%) with post-operative COVID-19 infection.…”

Section: The Risks For Patients Undergoing Surgerymentioning

confidence: 91%

The Urologist, Personal Protective Equipment (PPE) and COVID-19

Mukherjee

Bonatsos

Raza

2020

Journal of Endoluminal Endourology

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Background and ObjectiveTo review the literature from a urologist’s perspective regarding the use of Personal Protective Equipment (PPE), associated challenges, and other potential measures that can be taken to reduce the risk of nosocomial COVID-19 transmission. Material and MethodsA literature review using PubMed, Cochrane Review, and Google Scholar database search was performed using the keyword terms “COVID-19”, “Coronavirus”, “Personal Protective Equipment” (PPE), “healthcare workers” (HCW), “protection”, “masks”, and “urology”. Non-English articles were excluded. We present a summary of key guidance provided by regulatory bodies as well as some of the key articles published to date relating to PPE. DiscussionSARS-CoV-2 virus is found mainly in the respiratory system but is also in blood, feces, semen, and urine. Both standard infection control precautions (SICPs) and transmission-based precautions (TBPs) are nec-essary to reduce nosocomial transmission of COVID-19 infection. PPE includes gowns, gloves, masks or respirators, goggles, and face shields; however, wearing PPE is only part of many precautionary measures that are necessary to prevent viral transmission. When used appropriately PPE not only protects HCWs from patients but also protects patients from HCWs who may be asymptomatic carriers of COVID-19 infection. Attention should also be paid to fit testing and fit checking, donning and doffing, and ever-evolving guide-lines on PPE. Wearing PPE for a long time is also technically challenging and may adversely affect surgical outcomes. Shortages of PPE in the supply chain during the peak of the pandemic as well as concerns about substandard PPE should be considered for a possible second wave of COVID-19. Other key measures to minimize nosocomial SARS-CoV-2 virus transmission are a symptom and temperature screening of patients and staff; controlling the flow of patients, staff, and relatives in hospitals; self-isolation by patients before elective surgery; a robust testing protocol for both patients and staff; patient and staff cohorting; physical distancing; good hand hygiene; respiratory etiquette including face coverings for patients, staff and visitors; proper disposal of waste and enhanced cleaning; thorough cleaning and sterilization of surgical equipment performed post-operatively; choosing suitable anesthetic methods to minimize aerosolization of the virus; and if possible ensuring a negative-pressure theatre environment while dealing with COVID-19 positive patients. As scientific and regulatory bodies continue to issue updated guidance as more data is collected and a better knowledge base is developed regarding COVID-19 employers and staff need to keep up to date with guidance also. ConclusionCOVID-19 will be around for the foreseeable future and infection rates may fluctuate as restrictions are eased. HCWs including urologists should take appropriate PPE measures not only in theatres, clinics, and endoscopy suits but also when performing simple tasks such as urine dipsticks, catheter, nephrostomy management, digital rectal examination (DRE), prostate biopsies, etc. as SARS-CoV-2 can be detected in feces, urine, and semen. Both employers and HCWs should adhere strictly to current guidelines and work together to minimize nosocomial transmission of COVID-19 infection.

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Evaluation of 30-day mortality for 500 patients undergoing non-emergency surgery in a COVID-19 cold site within a multicentre regional surgical network during the COVID-19 pandemic

Cited by 7 publications

References 19 publications

Safety of ‘hot’ and ‘cold’ site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic

Safety of ‘hot’ and ‘cold’ site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic

New geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study

The Urologist, Personal Protective Equipment (PPE) and COVID-19

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