Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board.
Journal
Surgery open science
ISSN: 2589-8450
Titre abrégé: Surg Open Sci
Pays: United States
ID NLM: 101768812
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
12
07
2022
revised:
29
08
2022
accepted:
12
09
2022
pubmed:
11
10
2022
medline:
11
10
2022
entrez:
10
10
2022
Statut:
ppublish
Résumé
The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
Sections du résumé
Background
UNASSIGNED
The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk.
Methods
UNASSIGNED
A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates.
Results
UNASSIGNED
Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality.
Conclusion
UNASSIGNED
This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
Identifiants
pubmed: 36211629
doi: 10.1016/j.sopen.2022.09.005
pii: S2589-8450(22)00058-6
pmc: PMC9531361
doi:
Types de publication
Journal Article
Langues
eng
Pagination
168-173Investigateurs
A Mohamed
(A)
G Blackshaw
(G)
R Thomas
(R)
S Jones
(S)
M Shinkwin
(M)
H Perry
(H)
D Edgbeare
(D)
S Chopra
(S)
L DaSilva
(L)
I Williams
(I)
U Contractor
(U)
S Bell
(S)
S Zaher
(S)
M Stechman
(M)
S Berry
(S)
H Clark
(H)
E Bois
(E)
C Von Oppell
(C)
L Ackerman
(L)
E Ablorsu
(E)
J Horwood
(J)
D Mehta
(D)
J Featherstone
(J)
E Folaranmi
(E)
M Bray
(M)
K Siddall
(K)
E King
(E)
M Phillips
(M)
J Morgan
(J)
I Chopra
(I)
D Evans
(D)
K Whitehouse
(K)
P Leach
(P)
C Thomas
(C)
E Davies
(E)
M Dyer
(M)
A Fox
(A)
E Ireland
(E)
E Meehan
(E)
A Mukit
(A)
K Newell
(K)
D Parry
(D)
B Popham
(B)
C Chapman
(C)
H Botros
(H)
Informations de copyright
© 2022 Published by Elsevier Inc.
Déclaration de conflit d'intérêts
There was no identified conflict of interest by any authors.