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

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. A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-ope...

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Published in:	Journal of plastic, reconstructive & aesthetic surgery Vol. 74; no. 1; pp. 211 - 222
Main Authors:	Miranda, B.H., Hughes, W.R.M., Pinto-Lopes, R., Mathur, B.S., Ramakrishnan, V.V., Sood, M.K., Ahmad, Fateh, Banwell, Miles E, Barnes, David E, El-Muttardi, Naguib, Griffiths, Matthew, Hussain, Amer, Iwuagwu, Fortune C, Kangesu, Loshan, Khan, Waseem, Martin, Niall, Mopuri, Nabil, Morgan, Mary, Morris, Paul, Rorison, Patricia, Shelley, Odhran, Sierakowski, Adam, Tare, Makarand, Tzafetta, Kallirroi, Zweifel, Claire J, Appukuttan, Aswin, Balgaumwala, Tasneem, Counter, Oliver, Deelip Dhake, Swapnil, Fernandez-Diaz, Oscar F, Gathura, Esther, Harris, Nicola, Constantin Ion Jica, Romulus, Katechia, Devvrat, Lavender, Scott, Martin, David G, Mertic, Alex, Miranda, Adela, Myers, Jo, Nasrallah, Fady, Pantelides, Nicholas, Prior, Sheila, Raveendran, Sreekanth, Sell, Tracey, Sinha, Reetu, Smeeton, Ben T, Smith, Alex C D, Sofos, Stratos, Strong, Ben, Tang, Jasmine Y M, Thacoor, Amitabh, Tucker, Anne, Turkentine, Michele, Cornforth, Mark, Cowdery, Sally, Marasca, Alessandro, Palmer, Helen, Watts, Carole, Watts, Jan, Wiltshire, Rachel, Sing, Quillan Young, Zberea, Diana E, Mabvuure, Nigel T
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-01-2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd
Subjects:	Adult Aged, 80 and over Burns Burns - surgery Coronavirus COVID-19 Elective Surgical Procedures England Female General surgery Hospitals Humans Injuries Male Middle Aged Patient Safety Plastic Prospective Studies Reconstructive Surgical Procedures Risk Assessment Surgery Trauma Wounds and Injuries - surgery England Coronavirus General surgery Surgery Plastic Burns Trauma Injuries
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Summary:	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. 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). 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Acknowledgements: Karen Cook, John Cooil, Stewart Cooper, Sue Dines, Dylan Featherstone, Natalie Knowles, Charlotte Mcallister, Francesca Turner, Michael Wiseman The St Andrew's Collaborative Authors: Fateh Ahmad, Miles E Banwell, David E Barnes, Naguib El-Muttardi, Matthew Griffiths, Amer Hussain, Fortune C Iwuagwu, Loshan Kangesu, Waseem Khan, Niall Martin, Nabil Mopuri, Mary Morgan, Paul Morris, Patricia Rorison, Odhran Shelley, Adam Sierakowski, Makarand Tare, Kallirroi Tzafetta, Claire J Zweifel, Aswin Appukuttan, Tasneem Balgaumwala, Oliver Counter, Swapnil Deelip Dhake, Oscar F Fernandez-Diaz, Esther Gathura, Nicola Harris, Romulus Constantin Ion Jica, Devvrat Katechia, Scott Lavender, David G Martin, Alex Mertic, Adela Miranda, Jo Myers, Fady Nasrallah, Nicholas Pantelides, Sheila Prior, Sreekanth Raveendran, Tracey Sell, Reetu Sinha, Ben T Smeeton, Alex C D Smith, Stratos Sofos, Ben Strong, Jasmine Y M Tang, Amitabh Thacoor, Anne Tucker, Michele Turkentine, Mark Cornforth, Sally Cowdery, Alessandro Marasca, Helen Palmer, Carole Watts, Jan Watts, Rachel Wiltshire, Quillan Young Sing, Diana E Zberea, Nigel T Mabvuure
ISSN:	1748-6815 1878-0539
DOI:	10.1016/j.bjps.2020.08.039