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

  1. Veeru Kasivisvanathan
  2. Jamie Lindsay
  3. Sara Rakshani-Moghadam
  4. Ahmed Elhamshary
  5. Konstantinos Kapriniotis
  6. Georgios Kazantzis
  7. Bilal Syed
  8. John Hines
  9. Axel Bex
  10. Daniel Heffernan Ho
  11. Martin Hayward
  12. Chetan Bhan
  13. Nicola MacDonald
  14. Simon Clarke
  15. David Walker
  16. Geoff Bellingan
  17. James Moore
  18. Jennifer Rohn
  19. Asif Muneer
  20. Lois Roberts
  21. Fares Haddad
  22. John D Kelly
  23. UCLH study group collaborators

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Abstract

Background

Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems.

Objective

To determine whether it is feasible and safe to continue non-emergency surgery in the COVID-19 pandemic

Design, setting and participants

This is a cohort study of 500 consecutive patients undergoing non-emergency surgery in a dedicated COVID-19 cold site following the first case of COVID-19 that was reported in the institution. The study was carried out during the peak of the pandemic in the United Kingdom, which currently has one of the highest number of cases and deaths from COVID-19 globally.

We set up a hub-and-spoke surgical network amongst 14 National Health Service institutions during the pandemic. The hub was a cancer centre, which was converted into a COVID-19 cold site, performing urological, thoracic, gynaecological and general surgical operations.

Outcomes

The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days.

Results

500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male and 60% had a known diagnosis of cancer. 44% of surgeries were performed with robotic or laparoscopic assistance and 61% were considered complex or major operations.

None of the 500 patients undergoing surgery died from COVID-19 at 30-days. 30-day allcause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19.

Conclusion

It is safe to continue non-emergency surgery during the COVID-19 pandemic with appropriate service reconfiguration.

Patient summary

No patients died from COVID-19 when undergoing non-emergency surgery during the pandemic in one of the worst affected world regions.

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    SciScore for 10.1101/2020.06.10.20115543: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: The institutional review board at University College London Hospital deemed this work exempt from ethical approval.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using STATA (version 14.2) software.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are a number of limitations in this study. First, not all of the patients were tested with a viral swab. This may underestimate the number of patients with confirmed laboratory diagnoses of COVID-19, though this may be mitigated by our assessment of patients for probable COVID-19 on the basis of their symptoms and in line with WHO guidelines [18]. Testing everyone in the community is not feasible in countries such as the UK, where testing capacity was limited, and government policy meant that testing was typically carried out for patients admitted to hospital. Second, this service reconfiguration approach may not be feasible in all healthcare settings. At other institutions, particularly those based in one building, it may not be possible to keep the site COVID-free. However, we would strongly recommend that neighbouring institutions work together to designate cold COVID sites amongst a group of institutions during these unprecedented times. Third, we should acknowledge the ethical dilemmas surrounding resource allocation at a time of limited resources and with uncertainty about where resources are best used [25]. The ability to offer such a service is dependent on local resources and the specific clinical situation, though models have been developed to allow planning for resource allocation during a pandemic [26]. It is ultimately down to the judgment of the regional healthcare system leaders whether it is appropriate and safe to offer the described approach.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.06.10.20115543v1 on medRxiv