TY - JOUR
T1 - Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU)
T2 - A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board
AU - Cardiff and Vale COVID-19 Research Collaborative
AU - Minto, T.
AU - Abdelrahman, T.
AU - Jones, L.
AU - Wheat, J.
AU - Key, T.
AU - Shivakumar, N.
AU - Ansell, J.
AU - Seddon, O.
AU - Cronin, A.
AU - Tomkinson, A.
AU - Theron, A.
AU - Trickett, R. W.
AU - Sagua, N.
AU - Sultana, S.
AU - Clark, A.
AU - McKay, E.
AU - Johnson, A.
AU - Behera, Karishma
AU - Towler, J.
AU - Kynaston, H.
AU - Mohamed, A.
AU - Blackshaw, G.
AU - Thomas, R.
AU - Jones, S.
AU - Shinkwin, M.
AU - Perry, H.
AU - Edgbeare, D.
AU - Chopra, S.
AU - DaSilva, L.
AU - Williams, I.
AU - Contractor, U.
AU - Bell, S.
AU - Zaher, S.
AU - Stechman, M.
AU - Berry, S.
AU - Clark, H.
AU - Bois, E.
AU - Von Oppell, C.
AU - Ackerman, L.
AU - Ablorsu, E.
AU - Horwood, J.
AU - Mehta, D.
AU - Featherstone, J.
AU - Folaranmi, E.
AU - Bray, M.
AU - Siddall, K.
AU - King, E.
AU - Phillips, M.
AU - Morgan, J.
AU - Fox, A.
N1 - Publisher Copyright:
© 2022
PY - 2022/10
Y1 - 2022/10
N2 - Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P <.001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P <.001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
AB - Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P <.001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P <.001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
UR - http://www.scopus.com/inward/record.url?scp=85140906809&partnerID=8YFLogxK
U2 - 10.1016/j.sopen.2022.09.005
DO - 10.1016/j.sopen.2022.09.005
M3 - Article
AN - SCOPUS:85140906809
SN - 2589-8450
VL - 10
SP - 168
EP - 173
JO - Surgery Open Science
JF - Surgery Open Science
ER -