The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic

Abstract

Background In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. Methods PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11–3-2020 to 13–9-2020. Results A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. Conclusion The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.

Safe Surgery During the COVID-19 Pandemic

“…Others have shown similar data in patients undergoing surgery for endocrine cancers and urology cancers [75,76]. Based on these studies, we believe that cancer surgery should continue during the pandemic with locally appropriate safety precautions that should probably include screening for symptoms and close contact with COVID-19 patients in 2 weeks leading up to surgery, preoperative RT-PCR testing, preoperative self-isolation after the testing (and for 2 weeks in those deemed at high risk of complications from perioperative SARS-CoV-2 infection), treatment in COVID-free or COVID-minimal facilities, and postoperative self-isolation for 2 weeks in the high-risk group.…”

Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19

“… 20 , 21 , 22 , 23 , 24 , 25 However, the literature is limited in studies assessing outcomes of endocrine surgery patients who had delays to their care due to COVID-19. 26 An international, multicenter, prospective cohort study evaluated outcomes of 380 emergency and elective endocrine surgery patients using data from PanSurg-PREDICT. 26 Although 97% of the surgeries captured by the database were considered elective, only 8.1% of patients had any delay in care due to COVID-19.…”

“… 26 An international, multicenter, prospective cohort study evaluated outcomes of 380 emergency and elective endocrine surgery patients using data from PanSurg-PREDICT. 26 Although 97% of the surgeries captured by the database were considered elective, only 8.1% of patients had any delay in care due to COVID-19. Of those with delays, a majority underwent surgery within three months and only one patient was delayed for more than six months.…”

A Pilot Study of Augmented Intelligence Risk-Based Stratification for Endocrine Surgical Waiting List Prioritisation

“…• Priority Level 6 (P6): patient wishes to postpone surgery due to non-COVID-19 concerns Furthermore, the coronavirus disease (COVID-19) pandemic resulted in cancellations of routine operative procedures and redeployment of staff onto acute medical specialities [6], which consequently resulted in the current pre-existing stratification of these patients becoming outdated with patients labelled as P3 being delayed to more than three months [7,8]. More specifically to endocrine surgery, surgical decision-making, case mix and personnel delivering care were significantly affected due to this pandemic [9].…”