Results of COVID-minimal Surgical Pathway During Surge-phase of COVID-19 Pandemic

Abstract

Objective: The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic. Summary of Background Data: Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a “COVID-minimal pathway” was created. Methods: Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The “COVID-minimal surgical pathway” consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections. Results: After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56–79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1–6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection. Conclusions: A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.

Surgical Treatment and Outcomes of Colorectal Cancer Patients During the COVID-19 Pandemic: A National Population-based Study in England

“…Other studies have demonstrated that the provision of COVID-19 “cold” sites reduces the risk of hospital-acquired COVID-19 infection and pulmonary complications. 15 , 28 , 44 – 46 …”

Differences in Emotional Distress Among Black and White Breast Cancer Survivors During the Covid-19 Pandemic: a National Survey

“…Emerging studies on cancer care delays during the pandemic have focused on the rate and type of delays [1,2], clinical responses and potential consequences [21][22][23], and risk of Covid-19 infection or mortality among cancer survivors [24][25][26][27]. Studies on psychological distress during the pandemic indicate that both women and those with existing health conditions are at greater risk for distress, but have not indicated racial differences or disparities [28,29].…”

Mortality after surgery with SARS-CoV-2 infection in England: A population-wide epidemiological study

“…Meanwhile, the very low risk of in-hospital death (one in 1000) among patients undergoing elective surgery who have not been infected with SARS-CoV-2 suggests that infection prevention and control procedures to create COVID-19-free ‘green’ surgical pathways have been highly effective during the pandemic. 20,21 Surgical patients with symptomatic SARS-CoV-2 infection were almost four times more likely to die compared to infected patients without respiratory symptoms.…”

“…1,2 However, patients and clinicians should be reassured that the population incidence of SARS-CoV-2 among surgical patients is low and the overall risk of death from SARS-CoV-2 for a patient undergoing elective surgery in a ‘green’ pathway is less than one in 16500. 20 The predicted delays to surgical treatments as a result of the pandemic are substantial, with an estimated five million cases outstanding by March 2021. 4 Although the morbidity and mortality associated with cancelled or postponed surgery is unknown, it is clearly not desirable to have a large and rapidly expanding waiting list for treatments.…”