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. 2021 Mar;103(3):173-179.
doi: 10.1308/rcsann.2020.7023. Epub 2021 Feb 9.

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

E G Burden  1 , R W Walker  1 , D J Ferguson  1   2 , Amf Goubran  1 , J R Howell  1 , J B John  1 , F Khan  1 , J S McGrath  1   2 , J P Evans  1   3
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The provision of a time-critical elective surgical service during the COVID-19 Crisis: a UK experience

E G Burden et al. Ann R Coll Surg Engl. 2021 Mar.

Abstract

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: COVID-19; Cancer; Elective; Patient safety; Surgery.

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Figures

Figure 1
Figure 1
Breakdown of cancer compared with benign work
Figure 2
Figure 2
Cases performed by surgical specialty
See this image and copyright information in PMC

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