A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

Veeru Kasivisvanathan¹, Jamie Lindsay², Sara Rakshani-Moghadam², Ahmed Elhamshary², Konstantinos Kapriniotis², Georgios Kazantzis², Bilal Syed², John Hines², Axel Bex³, Daniel Heffernan Ho⁴, Martin Hayward⁵, Chetan Bhan⁶, Nicola MacDonald⁷, Simon Clarke⁸, David Walker⁹, Geoff Bellingan¹⁰, James Moore¹¹, Jennifer Rohn¹², Asif Muneer¹³, Lois Roberts¹⁴, Fares Haddad¹⁵, John D Kelly¹⁶; UCLH study group collaborators

Collaborators, Affiliations

Collaborators

UCLH study group collaborators:
Tarek Ezzatt Abdel-Aziz, Clare Allen, Sian Allen, Hussain Alnajjar, Daniella Andrich, Vimoshan Arumuham, Naaila Aslam, Ravi Barod, Rosie Batty, Timothy Briggs, Eleanor Brockbank, Manish Chand, Simon Choong, Nim Christopher, Justin Collins, James Crosbie, Louise Dickinson, Konstantinos Doufekas, Mark Feneley, Tamsin Greenwell, Alistair Grey, Rizwan Hamid, John Hines, Julie Jenks, Arjun Jeyarajah, Davor Jurkovic, Anand Kelkar, Ioannis Kotsopoulos, Tomasz Kurzawinski, David Lawrence, Chi-Ying Li, Robert May, Jonathan McCullough, Sofoklis Mitsos, Caroline Moore, Tim Mould, Anthony Mundy, Senthil Nathan, Robert Nicolae, Jeremy Ockrim, Adeola Olaitan, Clement Orczyk, Mahreen Pakzad, Nikolaos Panagiotopoulos, Prasad Patki, Davide Patrini, Douglas Pendse, Saurabh Phadnis, Prabhakar Rajan, David Ralph, Tommy Rampling, Pippa Sangster, Greg Shaw, Daron Smith, Prasanna Sooriakumaran, Ashwin Sridhar, Tom Strange, Maxine Tran, Dimitrios Volanis, Dan Wood, Christopher Wood

Affiliations

¹ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK. Electronic address: veeru.kasi@ucl.ac.uk.
² Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
³ Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK.
⁴ Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
⁵ Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK.
⁶ Department of General Surgery, Whittington Health NHS Trust, London, UK.
⁷ Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK.
⁸ Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK.
⁹ Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK.
¹⁰ Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK.
¹¹ NHS England and NHS Improvement, England, UK.
¹² Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK.
¹³ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK.
¹⁴ Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK.
¹⁵ Division of Surgery and Interventional Science, University College London, London, UK.
¹⁶ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.

PMID: 33122153
PMCID: PMC7584883
DOI: 10.1016/j.ijsu.2020.10.019

A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

Veeru Kasivisvanathan et al. Int J Surg. 2020 Dec.

. 2020 Dec:84:57-65.

doi: 10.1016/j.ijsu.2020.10.019. Epub 2020 Oct 24.

Authors

Collaborators

UCLH study group collaborators:
Tarek Ezzatt Abdel-Aziz, Clare Allen, Sian Allen, Hussain Alnajjar, Daniella Andrich, Vimoshan Arumuham, Naaila Aslam, Ravi Barod, Rosie Batty, Timothy Briggs, Eleanor Brockbank, Manish Chand, Simon Choong, Nim Christopher, Justin Collins, James Crosbie, Louise Dickinson, Konstantinos Doufekas, Mark Feneley, Tamsin Greenwell, Alistair Grey, Rizwan Hamid, John Hines, Julie Jenks, Arjun Jeyarajah, Davor Jurkovic, Anand Kelkar, Ioannis Kotsopoulos, Tomasz Kurzawinski, David Lawrence, Chi-Ying Li, Robert May, Jonathan McCullough, Sofoklis Mitsos, Caroline Moore, Tim Mould, Anthony Mundy, Senthil Nathan, Robert Nicolae, Jeremy Ockrim, Adeola Olaitan, Clement Orczyk, Mahreen Pakzad, Nikolaos Panagiotopoulos, Prasad Patki, Davide Patrini, Douglas Pendse, Saurabh Phadnis, Prabhakar Rajan, David Ralph, Tommy Rampling, Pippa Sangster, Greg Shaw, Daron Smith, Prasanna Sooriakumaran, Ashwin Sridhar, Tom Strange, Maxine Tran, Dimitrios Volanis, Dan Wood, Christopher Wood

Affiliations

¹ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK. Electronic address: veeru.kasi@ucl.ac.uk.
² Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
³ Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK.
⁴ Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
⁵ Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK.
⁶ Department of General Surgery, Whittington Health NHS Trust, London, UK.
⁷ Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK.
⁸ Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK.
⁹ Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK.
¹⁰ Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK.
¹¹ NHS England and NHS Improvement, England, UK.
¹² Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK.
¹³ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK.
¹⁴ Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK.
¹⁵ Division of Surgery and Interventional Science, University College London, London, UK.
¹⁶ Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.

PMID: 33122153
PMCID: PMC7584883
DOI: 10.1016/j.ijsu.2020.10.019

Abstract

Background: Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems.

Methods: During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days.

Results: 500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19.

Conclusion: It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration.

Keywords: COVID-19; Cancer; Cold site; Mortality; Network; Safety; Surgery.

PubMed Disclaimer

Conflict of interest statement

The authors have no relevant conflicts of interest.

Figures

**Fig. 1**
Title: Timeline of key events during the studyNote: timeline is not to scale. Jan = January, Mar = March, Apr = April.

See this image and copyright information in PMC

References

1. Soreide K., Hallet J., Matthews J.B., Schnitzbauer A.A., Line P.D., Lai P.B.S., et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br. J. Surg. 2020;30(10):1250–1261. - PMC - PubMed
1. Collaborative C, Nepogodiev D, Bhangu A. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. BJS (British Journal of Surgery).n/a(n/a). 107(11), 1440-1449. - PMC - PubMed
1. Sud A., Jones M.E., Broggio J., Loveday C., Torr B., Garrett A., et al. Collateral damage: the impact on cancer outcomes of the COVID-19 pandemic. medRxiv. 2020:2020. 04.21.20073833. - PMC - PubMed
1. Chu A.T., Holt S.K., Wright J.L., Ramos J.D., Grivas P., Yu E.Y., et al. Delays in radical cystectomy for muscle-invasive bladder cancer. Cancer. 2019;125(12):2011–2017. - PubMed
1. AlHilli M.M., Elson P., Rybicki L., Khorana A.A., Rose P.G. Time to surgery and its impact on survival in patients with endometrial cancer: a National cancer database study. Gynecol. Oncol. 2019;153(3):511–516. - PubMed

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A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

Collaborators

Affiliations

A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical