Peri‐operative COVID‐19 infection in urgent elective surgery during a pandemic surge period: a retrospective observational cohort study

Abstract

Summary Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID‐19) pandemic is challenging and it is not clear how COVID‐19 may impact peri‐operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, we establish if implementation of a bespoke peri‐operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID‐19‐associated complication profile. We present a single‐centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID‐19 surge in the UK between 29 March and 12 June 2020. Patients asymptomatic for COVID‐19 were screened by oronasal swab and chest imaging (chest X‐ray or computed tomography if aged ≥ 18 years), proceeding to surgery if negative. COVID‐19 positive patients at screening were delayed. Postoperatively, patients transitioning to COVID‐19 positive status by reverse transcriptase polymerase chain reaction testing were identified by an in‐house tracking system and monitored for complications and death within 30 days of surgery. Out of 557 patients referred for surgery (230 (41.3%) women; median (IQR [range]) age 61 (48–72 [1–89])), 535 patients (96%) had COVID‐19 screening, of which 13 were positive (2.4%, 95%CI 1.4–4.1%). Out of 512 patients subsequently undergoing surgery, 7 (1.4%) developed COVID‐19 positive status (1.4%, 95%CI 0.7–2.8%) with one COVID‐19‐related death (0.2%, 95%CI 0.0–1.1%) within 30 days. Out of these seven patients, four developed pneumonia, of which two required invasive ventilation including one patient with acute respiratory distress syndrome. Low rates of COVID‐19 infection and mortality in the elective surgical population can be achieved within a targeted care bundle. This should provide reassurance that elective surgery can continue, where possible, despite high community rates of COVID‐19.

SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

“…Elective surgery after SARS-CoV-2 infection must be safe for staff, other patients and the public [16][17][18][19]. Therefore, adherence to self-isolation guidelines is imperative.…”

UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

“…Kane et al demonstrated that low rates of COVID-19 infection and mortality in the elective surgical population could be achieved by using a targeted care bundle. 34 Modifications were suggested at every stage of the perioperative pathway in order to protect both staff and patients from the risks of COVID-19. 35 Important decisions surrounding surgeries had to be implemented quickly and were often based on day-to-day experiences and reflected the rapidly evolving nature of the situation and the associated evidence.…”

The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

“…The results of this study are in line with many other similar studies in various health care centers. 11,12,17 Research comparing the availability of a COVID-19-free operation route with the unavailability of a COVID-19free operating route found that the post-operative patient SARS-CoV-2 infection rate was lower level in the COVID-19-free operation route. 12,18,19 It should be noted that COVID-19 infection without a COVID-19free surgical route in post-operative patients is around 5% with a mortality rate of 25%.…”