Safety of cancer surgery during the COVID-19 pandemic

Rodríguez‐Sanjuán, Juan Carlos; Castanedo, S; Toledo, Eliana; Calleja, Patricia; Jimeno, José Carlos Pastor; Gómez, María Lorena; Anderson, Edward; Gutiérrez-Baños, J.L.

doi:10.1002/bjs.11767

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Despite the international implementation of practice modification to address the COVID-19 pandemic, there still remains a paucity of prospective, patient-centred and controlled studies regarding the safety of continuing surgery for patients. 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 By the end of this study period (June 2020), the estimated UK prevalence and death rate were approximately 4400 and 600 per million population respectively; at this time, the UK was amongst the top 5 most affected countries in terms of confirmed cases and deaths per million population. 4 , 28 This represents a stark contrast to other highly populated countries, such as India, who at this time were amongst the top 5 most affected countries by having 590,000 confirmed cases and 17,000 deaths, but were amongst the least affected countries by disease spread through the population; this in part is reflected in a lower prevalence (400 per million population) and death rate (12 per million population).…”

Section: Discussionmentioning

confidence: 92%

“…20 Healthcare service provision has been significantly limited internationally to mitigate COVID-19 related risk; our findings are therefore vital for healthcare providers when considering service adaptations to re-instate patient treatment. 1 , 15 , 26 , 29 We continue to adapt according to the literature and national guidelines to maintain a safe and efficient patient service.…”

Section: Discussionmentioning

confidence: 99%

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St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

Miranda

Hughes

Pinto-Lopes

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Introduction This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines. Method A prospective cohort study was undertaken in all patients who underwent surgical ( n = 1429) or non-operative ( n = 191) management during the UK COVID-19 pandemic peak (April–May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). Results Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups ( p = 0.236). Conclusion We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

Miranda

Hughes

Pinto-Lopes

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

View full text Add to dashboard Cite

show abstract

“…These highly encouraging results were achieved with significant service changes that were rapidly implemented to protect this patient group. Healthcare service provision has been significantly limited internationally to mitigate COVID-19 related risk; our findings are therefore vital for healthcare providers when considering service adaptations to re-instate patient treatment [4,20,35,36]. We continue to adapt according to the literature and national guidelines to maintain a safe and efficient patient service.…”

Section: Discussionmentioning

confidence: 96%

“…Despite practice modification being implemented on an international scale to address the COVID-19 pandemic, there still remains a paucity of prospective patient-centred studies regarding the safety of continuing surgery for patients [16][17][18][19][20]. By the end of this study period (June 2020), the estimated UK prevalence and death rate were approximately 4400 and 600 per million population respectively; therefore at this time, the UK was amongst the top 5 most affected countries in terms of confirmed cases and deaths per million population [7].…”

Section: Discussionmentioning

confidence: 99%

St Andrew’s COVID-19 Surgery Safety (StACS) study: Skin cancer

Miranda

Jica

Pinto-Lopes

et al. 2021

Journal of Plastic Surgery and Hand Surgery

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Background: Skin cancer represents the most common malignancy worldwide and it is imperative that we develop strategies to ensure safe and sustained delivery of cancer care which are resilient to the ongoing impact of COVID-19.Objective: This study prospectively evaluates the COVID-19 related patient risk and skin cancer management at a single tertiary referral centre, which rapidly implemented national COVID-19 safety guidelines. Method: A prospective cohort study was performed in all patients who underwent surgery for elective skin cancer service management, during the UK COVID-19 pandemic peak (April-May 2020). 'Real-time' 30-day hospital database deceased data were collected. Random selection was undertaken for patients who either underwent operative (surgery group) management or remained on the waiting list (control group); these groups were also prospectively followed-up within a controlled cohort study design and telephoned at the end of June 2020 for the control group or 30 days post-operatively. Results: Of the 767 patients who had operations, there were no COVID-19 related deaths. Both the surgery (n ¼ 384) and control (n ¼ 100) groups were matched for age, sex, ethnicity, BMI, presence of comorbidities, smoking and positive COVID-19 contact. There were no differences in post-operative versus any symptom development (1.3%, 5/384 vs. 4%, 4/100, p ¼ 0.093), or proportion of positive tests (8.6%, 33/ 384 vs. 8%, 8/100; p ¼ 0.849), between the surgery and control groups. Conclusion: These data support continued and safe service provision, and no increased risk to skin cancer patients who require surgical management, which is vital for continuation of cancer treatment in the context of a pandemic.

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Elective Gastrointestinal Surgery in COVID Times

et al. 2020

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With the COVID pandemic claiming deaths the world over, the healthcare systems were overburdened. This led to the cancellation and delay in elective surgical cases which can have far-reaching consequences This study reports our experience of elective gastro-intestinal surgical procedures during the COVID pandemic, after instating preventive strategies and screening protocols to prevent the transmission of COVID infection. This is a case series analysis of elective gastro-intestinal surgical procedures performed from March 24, 2020, to July 31, 2020. During this period, 314 gastro-intestinal surgical procedures were performed; of which, 45% were for malignancies. The median age of patients was 54 years (range 8 to 94 years). Laparoscopy was used in 43% cases. Major postoperative complications (Clavien-Dindo grade 3 and above) were witnessed in 3.5% (11/314) patients, with no statistically significant difference when compared with the rate of major complications last year (45/914, 4.9% vs 11/314, 3.5%, p = 0.3). The 30-day mortality rate was 1% ( n = 3). No patient developed COVID in the postoperative period. With preventive and screening strategies and proper patient selection, it is possible to deliver safe GI surgical services during the COVID pandemic, without increasing the risk for major postoperative complications.

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Safety of cancer surgery during the COVID-19 pandemic

Cited by 4 publications

References 3 publications

St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

St Andrew’s COVID-19 Surgery Safety (StACS) study: Skin cancer

Elective Gastrointestinal Surgery in COVID Times

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