167 The Experience and Outcomes of Elective Urgent and Cancer Surgery in A District General Hospital in The United Kingdom During Covid-19 Pandemic

Abstract

Background Many urgent and elective surgeries were postponed to cope with the Coronavirus disease (COVID-19) pandemic, with latest data found a substantial postoperative mortality risk (25·6%, 18.9%) after emergency and elective surgery, respectively. Our institution was one of the first trust to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic. The aim of this study is to analyse the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK. Method Retrospective analysis of outcomes all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway”. The primary endpoints were 30 days mortality and COVID related morbidities, and the secondary endpoints were surgical related complications and oncological outcomes. Results 92 patients (Male:45%; Female:55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications. Conclusions It is possible to mitigate the high mortality risk of postoperative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

“…Italian and French studies respectively described an institutional policy to proceed with elective procedures for oncologic indications [ 6 , 7 , 21 ]. Eight studies reported a prohibition on hospital visitation [ 6 , 21 , 22 , 26 , 61 , 63 , 64 , 66 ]. One of these studies described telephonic updates to consenting patients’ relatives, provided by the Surgery Unit Chief [ 21 ].…”

“…Adequate stockage and preservation of PPE, especially for high-risk procedures, was widely recommended [ 7 , 18 , 24 , 26 , 58 , 60 , 65 ]. Demarcated areas for ‘donning and doffing’ were erected at U.K.-based and Italian institutions [ 6 , 63 ]. Lastly, one study discussed ensuring an ongoing supply of oncologic drugs, considering an increased reliance on non-surgical therapy at an Indian institution [ 64 ].…”

“…Across European institutions, hospital personnel were trained on hygiene measures; nurses, specifically, were trained to implement other mitigation measures, service dedicated COVID-19 units and provide home-based healthcare postoperatively [ 6 , 7 , 21 , 26 , 63 ]. Training on the diagnosis and management of (postoperative) COVID-19 has also been emphasised [ 55 ].…”

“…In a U.S. context, out-of-state patients, travelling to access elective surgery, completed a mandatory, pre-operative 14-day quarantine [ 65 ]. In the U.K., to prevent possible healthcare facility-level outbreaks of (community-acquired) SARS-COV-2, patients requested their household contacts to adhere to a 2-week quarantine pre- and post-procedure [ 63 ]. The approach of many institutions was to consider all presenting patients as individuals with SARS-CoV-2 infection unless proven otherwise [ 60 ].…”

“…To shorten hospital stay and optimise hospital bed capacity, 6 studies reported that patient discharges from hospital were expedited [ 21 , 38 , 61 – 63 , 67 ].…”