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

Abstract

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.

Repercusión de la infección por SARS-CoV-2 en las intervenciones de Cirugía Plástica en Andalucía (España) durante la primera fase de pandemia COVID-19

“…(22,23) tomando las medidas establecidas por los protocolos vigentes en el momento, tal y como se ha hecho en otros centros de referencia como el St. Andrew's Hospital en el Reino Unido. (24) Es preciso mencionar que existe un sesgo en los tipos de cirugía realizados en este intervalo de tiempo, dado que, por normativas sanitarias, existió una reducción de las cirugías mayores. La situación de pandemia y los requerimientos de camas hospitalarias y asistencia a pacientes con COVID-19, motivó durante los meses de marzo a agosto una reducción significativa de las cirugías no urgentes en España, al igual que en otros países.…”

The burned patient in times of COVID-19: proposal derived from lessons learned

“…In places where such systems do not exist, this is an opportunity to set themup, and once the pandemic is over, they can be immensely helpful in providing timely care, and they are cost-effective for patients. During the pandemic, adaptation of burn unit is key to ensure that a successful recovery will restore high-quality medical care services 15 (evidence level 5).…”

Shifting the paradigm: ankylosis arthroplasty for the proximal interphalangeal joint with a novel collateral ligament reconstruction

“…As operative management is rarely undertaken for ankylosed small joints of the finger, there have only been two case reports in the literature for PIPJ ankylosis arthroplasty in RA (Awan and Imbriglia, 2016; Uemura et al., 2022). As a result of the COVID-19 pandemic, delays in elective hand surgery care resulted in patients with advanced arthritis developing PIPJ ankylosis while awaiting arthroplasty (Herren et al., 2022; Iacobucci, 2020; Miranda et al., 2021a, 2021b). Due to the significant impact that ankylosis had on their hand function, some patients opted for arthroplasty because of the potential increase in range of motion (ROM) (Cochiarella and Andersson, 2001).…”