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

Abstract

Introduction: 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.

Method: 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).

Results: 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).

Conclusion: 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.

Keywords: Burns; Coronavirus; General surgery; Injuries; Plastic; Surgery; Trauma.

Figure 1

Specialist Centre Activity (2019). There were 23,966 new tertiary referrals, and 13,845 operations performed between January and December 2019. There were 16,767 elective, 5240 trauma and 1959 new burns referrals. There were 9775 elective, 3556 trauma and 514 burns operations performed for patients.

Figure 2

One-way traffic operating pathway. Arrows indicate the direction of flow through theatre, for both patients and staff. HCA = Health Care Assistant; ODP = Operating Department Practitioner.

Figure 3

Specialist centre activity during the COVID-19 UK pandemic peak (April–May 2020) and previous year (April–May 2019). A total of 2391 referrals, and 1482 operations were performed during the UK pandemic peak (April–May 2020); this represented a decrease by 43% in referrals (4196) and by 34% in performed operations (2262) compared to the previous year (April–May 2019). There were 1337 elective, 731 trauma and 323 burns referrals during April–May 2020, versus 2780 elective, 1112 trauma and 304 burns referrals during April–May 2019. There were 855 elective, 566 trauma and 61 burns operations performed during April–May 2020, versus 1592 elective, 589 trauma and 81 burns operations performed during April–May 2019.