The Safety of Contemporary Planned Cancer Surgery During the COVID-19 Pandemic

  1. D Shackley
  2. S Gray
  3. S Penney
  4. L Galligan-Dawson
  5. F Howle
  6. S Arya
  7. J Hunter
  8. F Andrews
  9. C Wasson
  10. M Luckas
  11. B Ryan
  12. J Eddleston
  13. C Brookes
  14. C Harrison

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Abstract

Introduction

The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has put an unprecedented burden on global healthcare, including detrimental implications for the volume and provision of surgical services. The aim of this audit was to assess if the planned surgical cancer care (both diagnostic for possible cancer, and treatment of known cancer) during this period of widespread community and hospital based COVID-19 infection resulted in patients acquiring symptomatic COVID-19 as a consequence of their surgical admission, and if so, what the impact on patients was.

Methods

A prospective audit of all patients undergoing elective cancer surgery in Greater Manchester operated on between 01/05/2020 and 31/06/2020 was undertaken after the introduction of specific peri operative COVID safety measures across Greater Manchester cancer surgical cells. The COVID related outcomes for all cancer patients operated on in Greater Manchester were recorded.

Results

Of the 1501 patients undergoing surgery, one (<0.1%) was diagnosed with COVID-19 in hospital within 14 days of surgery. This patient did not require admission to critical care due to post-operative COVID-19 diagnosis, and there was no associated mortality related to post-operative COVID-19 infection.

Conclusion

The use of peri operative COVID-19 infection prevention strategies has allowed for the safe continuation of elective cancer surgery during this pandemic in all surgical units, without significant additional COVID-19 related morbidity or mortality.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.19.20207803: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    The limitations of this study design include potentially not identifying cases of asymptomatic COVID-19 positive patients post operatively or those who, after discharge, developed symptomatic COVID that did not require hospital admission. This is because all post operative patients were not routinely re-tested for COVID-19 unless symptoms or clinical deterioration occurred in a hospital setting within 14 days of surgery, or they remained in hospital for > 7 days (when routine testing was performed). An additional limitation is the unknown compliance of individuals with the 14 day pre-operative self-isolation protocol. Additionally, the bio-safety measures of green areas were adopted as ‘principles’ with every effort taken to avoid patient or staff–cross contamination but this could not be guaranteed in all settings particularly in the earlier phase of the audit period. Although these concerns are valid, they had no detrimental effect on the COVID-19 related outcomes in our cohort of patients which remain favourable. The strategies utilised for the peri operative screening and prevention of COVID-19 infection in Greater Manchester are replicable. However, it is important to bear in mind that peri operative patient self-isolation, designated COVID-secure facilities and systematic pre-operative COVID-19 screening requires significant resources and infrastructure. These resources include the economic loss of a patient adhering to 14 days of self-isolation, and compliance with thi...

    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 10.1101/2020.10.19.20207803v1 on medRxiv