Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • James C Glasbey, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Dmitri Nepogodiev, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Joana F F Simoes, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Omar Omar, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Elizabeth Li, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Mary L Venn, Queen Mary Univ London, Queen Mary University London, University of London, Barts & London Sch Med & Denistry
  • ,
  • Pgdme, Queen Mary Univ London, Queen Mary University London, University of London, Barts & London Sch Med & Denistry
  • ,
  • Mohammad K Abou Chaar, King Hussein Cancer Foundation: King Hussein Cancer Center
  • ,
  • Vita Capizzi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
  • ,
  • Daoud Chaudhry, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Anant Desai, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
  • ,
  • Jonathan G Edwards, Renal Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
  • ,
  • Jonathan P Evans, Nottingham University Hospitals NHS Trust
  • ,
  • Marco Fiore, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
  • ,
  • Jose Flavio Videria, Francisco Gentil Portuguese Institute for Oncology of Porto: Instituto Português de Oncologia do Porto Francisco Gentil EPE
  • ,
  • Samuel J Ford, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
  • ,
  • Ian Ganly, Mem Sloan Kettering Canc Ctr, Memorial Sloan Kettering Cancer Center, Computat Biol Ctr
  • ,
  • Ewen A Griffiths, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
  • ,
  • Rohan R Gujjuri, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • Angelos G Kolias, Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom; Cambridge Systems Biology Centre, University of Cambridge, Cambridge, United Kingdom;
  • ,
  • Haytham M A Kaafarani, Harvard School of Dental Medicine and Harvard Medical School
  • ,
  • Ana Minaya-Bravo, Henares University Hospital: Hospital Universitario del Henares
  • ,
  • Siobhan C McKay, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
  • ,
  • Helen M Mohan, St. James Institute of Oncology, St. James Hospital
  • ,
  • Keith J Roberts, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
  • ,
  • Carlos San Miguel-Méndez, Henares University Hospital: Hospital Universitario del Henares
  • ,
  • Peter Pockney, Newcastle University, Newcastle, U.K.
  • ,
  • Richard Shaw, Liverpool Business Sch, Liverpool John Moores University, University of Liverpool
  • ,
  • Neil J Smart, Royal Devon and Exeter NHS Foundation Trust
  • ,
  • Grant D Stewart, Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom; Cambridge Systems Biology Centre, University of Cambridge, Cambridge, United Kingdom;
  • ,
  • Sudha Sundar Mrcog, Auckland City Hospital, Auckland City Hospital, Grafton, Auckland, New Zealand.
  • ,
  • Raghavan Vidya, Royal Wolverhampton Hospitals NHS Trust
  • ,
  • Aneel A Bhangu, National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  • ,
  • COVIDSurg Collaborative

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway.

PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation).

RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76).

CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Oncology
Vol/bind39
Nummer1
Sider (fra-til)66-78
Antal sider13
ISSN0732-183X
DOI
StatusUdgivet - jan. 2021

Se relationer på Aarhus Universitet Citationsformater

ID: 207767695