The provision of a time-critical elective surgical service during the COVID-19 Crisis: a UK experience

With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortal...

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Bibliographic Details
Published in:	Annals of the Royal College of Surgeons of England Vol. 103; no. 3; pp. 173 - 179
Main Authors:	Burden, E G, Walker, R W, Ferguson, D J, Goubran, Amf, Howell, J R, John, J B, Khan, F, McGrath, J S, Evans, J P
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-03-2021 Royal College of Surgeons
Subjects:	Abdomen Adolescent Adult Aerosols Aged Aged, 80 and over Ambulatory Surgical Procedures - methods Arteriovenous Shunt, Surgical Cancer Cardiac Catheterization Coronaviruses COVID-19 COVID-19 diagnostic tests COVID-19 Nucleic Acid Testing Critical care Delivery of Health Care - organization & administration Disease transmission Elective Surgical Procedures - methods Female Hospitalization - statistics & numerical data Hospitals Humans Hysterectomy Intensive care Male Mass Screening Middle Aged Mortality Neoplasms - surgery Outcomes Pandemics Patient Readmission - statistics & numerical data Patients Postoperative Complications - epidemiology SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Surgery Surgical outcomes Surgical Procedures, Operative - methods Time-to-Treatment United Kingdom - epidemiology Urologic Surgical Procedures Workforce planning Young Adult United Kingdom United Kingdom > UK England COVID-19 Patient safety Elective Surgery Cancer
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Summary:	With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0035-8843 1478-7083
DOI:	10.1308/RCSANN.2020.7023