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. 2022 Oct:10:168-173.
doi: 10.1016/j.sopen.2022.09.005. Epub 2022 Oct 4.

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

T Minto  1 , T Abdelrahman  1 , L Jones  1 , J Wheat  1 , T Key  1 , N Shivakumar  1 , J Ansell  1 , O Seddon  1 , A Cronin  1 , A Tomkinson  1 , A Theron  1 , R W Trickett  1 , N Sagua  2 , S Sultana  2 , A Clark  2 , E McKay  2 , A Johnson  2 , Karishma Behera  2 , J Towler  2 , H Kynaston  1   2 ; Cardiff and Vale COVID-19 Research Collaborative
Collaborators, Affiliations

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

T Minto et al. Surg Open Sci. 2022 Oct.

Abstract

Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk.

Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates.

Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality.

Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.

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Conflict of interest statement

There was no identified conflict of interest by any authors.

Figures

Fig 1
Fig 1
Classification of hospital/community transmission.
Fig 2
Fig 2
Community prevalence of positive swabs compared with in-hospital positive results.
See this image and copyright information in PMC

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