Is a “COVID-19-free” hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study

Abstract

Background Resumption of elective surgery during the current coronavirus disease 2019 pandemic crisis has been debated widely and largely discouraged. The aim of this prospective cohort study was to assess the feasibility of resuming elective operations during the current and possible future peaks of this coronavirus disease 2019 pandemic. Methods We collected data during the peak of the current pandemic in the United Kingdom on adult patients who underwent elective surgery in a “COVID-19-free” hospital from April 8 to May 29, 2020. The study included patients from various surgical specialties. Nonelective and pediatric cases were excluded. The primary outcome was 30-day mortality postoperatively. Secondary outcomes were the rate of coronavirus disease 2019 infections, new onset of pulmonary symptoms after hospitalization, and requirement for admission to the intensive care unit. Results A total of 309 consecutive adult patients were included in this study. No patients died nor required intensive care unit admission. Operations graded “Intermediate” were the most performed procedure representing 91% of the total number. One patient was diagnosed with a coronavirus disease 2019 infection after being transferred to the nearest local emergency hospital for management of postoperative pain secondary to common bile duct stone and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. Twenty-seven patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo classification occurred in 14 and 2 patients, respectively. Conclusion This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 disease, COVID-19-free hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic.

Restarting Elective Bariatric and Metabolic Surgery Under a Security Protocol During the COVID-19 Pandemic—a Prospective Observational Cohort Study

“…Ferenczi et al [ 17 ], from Virginia Medical Center, tested 840 patients during the preoperative period with 3 positive tests that were rescheduled, demonstrating the utility of preoperative screening as a safe way to prevent surgery in asymptomatic COVID patients. Gammeri et al [ 22 ] reported excellent results of performing RT-PCR tests for every patient scheduled for surgery during the outbreak in the UK at a COVID-19-free hospital. Of the 309 patients operated on, no one had COVID-19 infection, but at least 1 patient had a positive test.…”

How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic

“…A recent UK-based study by Gammeri et al 32 reported on 309 NHS patients who underwent planned surgery at a COVID-free independent sector hospital. Like the present study, there were no adverse outcomes and no mortality within 30 days of surgery.…”

“…Like the present study, there were no adverse outcomes and no mortality within 30 days of surgery. However, the patient cohort was different: Gammeri et al 32 only performed surgery on low-risk patients undergoing procedures that could be performed as day cases or within 23 hour stays. Our study presents a simple method to prioritize patients, based on the FSSA procedural guide and incorporating additional biopsychosocial factors.…”

“…The FSSA guide considers that depending on the underlying disease and progression, a given procedure may be expedited to avoid prejudicing its outcome. 18 Gammeri et al 32 did not report the use of a procedural prioritization method but did employ a risk assessment tool to identify the lowest-risk patients. Anoushiravani et al 33 present an orthopaedic procedural prioritization guide, but recommend that all arthroplasty (which was the second most common and therefore urgent procedure performed in our study) is performed within three to six months.…”

Can surgery continue safely during a pandemic? A commentary on “Surgical activity during the Covid-19 pandemic: Results for 112 patients in a French tertiary care center, a quality improvement study”

“…Once the COVID status of the patient is known, they can be allocated to either a ‘COVID positive’ ward or a ‘COVID free’ ward and then their surgery can be managed appropriately with the correct level of PPE. A UK study showed that using ‘COVID-19 free’ hospitals, where the patients were neither suspected nor proven to be infected with SARS-CoV-2 virus, enabled safe elective surgery to proceed without serious adverse outcomes [ 4 ]. ‘COVID-free’ areas may indeed be paramount to ensuring that safe surgery may continue without complications due to COVID-19.…”