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
© 2022 Published by Elsevier Inc..
Background: 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: 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: 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: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
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| Enthalten in: |
Surgery open science - 10(2022) vom: 15. Okt., Seite 168-173 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Minto, T [VerfasserIn] |
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Date Revised 21.10.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.sopen.2022.09.005 |
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| Förderinstitution / Projekttitel: |
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NLM347268978 |
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| 100 | 1 | |a Minto, T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU) |b A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board |
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| 500 | |a Date Revised 21.10.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022 Published by Elsevier Inc. | ||
| 520 | |a Background: 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 | ||
| 520 | |a Methods: 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 | ||
| 520 | |a Results: 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 | ||
| 520 | |a Conclusion: 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 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Abdelrahman, T |e verfasserin |4 aut | |
| 700 | 1 | |a Jones, L |e verfasserin |4 aut | |
| 700 | 1 | |a Wheat, J |e verfasserin |4 aut | |
| 700 | 1 | |a Key, T |e verfasserin |4 aut | |
| 700 | 1 | |a Shivakumar, N |e verfasserin |4 aut | |
| 700 | 1 | |a Ansell, J |e verfasserin |4 aut | |
| 700 | 1 | |a Seddon, O |e verfasserin |4 aut | |
| 700 | 1 | |a Cronin, A |e verfasserin |4 aut | |
| 700 | 1 | |a Tomkinson, A |e verfasserin |4 aut | |
| 700 | 1 | |a Theron, A |e verfasserin |4 aut | |
| 700 | 1 | |a Trickett, R W |e verfasserin |4 aut | |
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| 700 | 1 | |a Johnson, A |e verfasserin |4 aut | |
| 700 | 1 | |a Behera, Karishma |e verfasserin |4 aut | |
| 700 | 1 | |a Towler, J |e verfasserin |4 aut | |
| 700 | 1 | |a Kynaston, H |e verfasserin |4 aut | |
| 700 | 0 | |a Cardiff and Vale COVID-19 Research Collaborative |e verfasserin |4 aut | |
| 700 | 1 | |a Mohamed, A |e investigator |4 oth | |
| 700 | 1 | |a Blackshaw, G |e investigator |4 oth | |
| 700 | 1 | |a Thomas, R |e investigator |4 oth | |
| 700 | 1 | |a Jones, S |e investigator |4 oth | |
| 700 | 1 | |a Shinkwin, M |e investigator |4 oth | |
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| 700 | 1 | |a Zaher, S |e investigator |4 oth | |
| 700 | 1 | |a Stechman, M |e investigator |4 oth | |
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| 700 | 1 | |a Ablorsu, E |e investigator |4 oth | |
| 700 | 1 | |a Horwood, J |e investigator |4 oth | |
| 700 | 1 | |a Mehta, D |e investigator |4 oth | |
| 700 | 1 | |a Featherstone, J |e investigator |4 oth | |
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| 700 | 1 | |a Siddall, K |e investigator |4 oth | |
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| 700 | 1 | |a Phillips, M |e investigator |4 oth | |
| 700 | 1 | |a Morgan, J |e investigator |4 oth | |
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| 700 | 1 | |a Evans, D |e investigator |4 oth | |
| 700 | 1 | |a Whitehouse, K |e investigator |4 oth | |
| 700 | 1 | |a Leach, P |e investigator |4 oth | |
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| 700 | 1 | |a Davies, E |e investigator |4 oth | |
| 700 | 1 | |a Dyer, M |e investigator |4 oth | |
| 700 | 1 | |a Fox, A |e investigator |4 oth | |
| 700 | 1 | |a Ireland, E |e investigator |4 oth | |
| 700 | 1 | |a Meehan, E |e investigator |4 oth | |
| 700 | 1 | |a Mukit, A |e investigator |4 oth | |
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| 700 | 1 | |a Botros, H |e investigator |4 oth | |
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