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

doi:10.1016/j.sopen.2022.09.005

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

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

Authors

T Minto¹, T Abdelrahman¹, L Jones¹, J Wheat¹, T Key¹, N Shivakumar¹, J Ansell¹, O Seddon¹, A Cronin¹, A Tomkinson¹, A Theron¹, R W Trickett¹, N Sagua², S Sultana², A Clark², E McKay², A Johnson², Karishma Behera², J Towler², H Kynaston^{1

2}; Cardiff and Vale COVID-19 Research Collaborative

Collaborators

Cardiff and Vale COVID-19 Research Collaborative:
A Mohamed, G Blackshaw, R Thomas, S Jones, M Shinkwin, H Perry, D Edgbeare, S Chopra, L DaSilva, I Williams, U Contractor, S Bell, S Zaher, M Stechman, S Berry, H Clark, E Bois, C Von Oppell, L Ackerman, E Ablorsu, J Horwood, D Mehta, J Featherstone, E Folaranmi, M Bray, K Siddall, E King, M Phillips, J Morgan, I Chopra, D Evans, K Whitehouse, P Leach, C Thomas, E Davies, M Dyer, A Fox, E Ireland, E Meehan, A Mukit, K Newell, D Parry, B Popham, C Chapman, H Botros

Affiliations

¹ University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW.
² School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN.

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.