Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...
Objective The objective of this study was to evaluate the impact of the COVID-19 pandemic on patient satisfaction and surgical outcomes at King Khalid University Hospital in Saudi Arabia. Background The COVID-19 pandemic has greatly affected health care systems across developing and developed countries. Therefore, it is important to understand its impact on various parameters of patient care as regards revised infrastructure and policies in hospitals during the pandemic. Method It is a retrospective cross-sectional study was conducted from 13-3–2020 to 26-4-2020 at King Khalid University Hospital in Saudi Arabia. Patient satisfaction and surgical outcomes were the main outcome measures. Results 331 participants were included in the study (median age: 53 years; 70% female), and 223 completed the patient's satisfaction survey. 260 of the surgeries were non-oncolog cases (78.6%) compared to 71 oncology cases (21.4%). With respect to the surgical outcomes, 12% of the patients required admission to the ICU, and 10.9% developed postoperative complications, most of which were infectious complications. Only 1.8% (6 patients) were re-admitted to the hospital. Three patients died within 30 days post-op (0.9%), all had emergency surgery. Regarding patient satisfaction, 77.6% and 93% of the patients reported that nurses and doctors, respectively, treated them with courtesy and respect, listened to them carefully, and provided clear explanations to them. 90.3% were satisfied with the hospital sanitary measures. 64.1% stated that they got written instructions at the time of discharge. Conclusion The satisfaction level of patients was high for all the studied domains, and there were a small number of complications with overall good surgical outcomes. That indicates that all the actions and policies that were implemented during the pandemic were proven beneficial for the patients. It is recommended to continue those measures until the COVID-19 pandemic is over.
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