Surgical Tribune International

COVID-19 free hospital areas could save lives after surgery

By University of Birmingham
October 27, 2020

BIRMINGHAM, UK: For fear that patients may contract COVID-19 in hospitals, millions of operations around the world were cancelled during the first wave of the pandemic. If operations for cancer and other time-dependent diseases are delayed, they may progress to be untreatable. Setting up COVID-19 free hospital areas for surgical patients could save lives during the second wave of the pandemic, a new global study has revealed.

Researchers of the CovidSurg Collaborative, an international consortium of scientists from over 130 countries, led by the University of Birmingham, examined data from 9,171 patients in 55 countries, across five different continents from the start of the pandemic up to the middle of April. The experts discovered that pulmonary complication (2.2% vs 4.9%) and rates of death after surgery (0.7% vs 1.7%) were lower for patients who received their hospital treatment in COVID-19 free areas. However, only 27% of the study participants were treated in these protected areas.

It is estimated that around 4.7 million operations take place in the UK each year, of which around 550,000 are for removal of cancer. Setting up COVID-19 free hospital areas could prevent 6,000 COVID-related deaths after cancer surgery in the UK alone over the next year.

Dr Aneel Bhangu, senior lecturer at the institute of cancer and genomic sciences at the University of Birmingham and co-lead author of the study, commented: “As health providers restart elective cancer surgery, they must look to protect cancer surgery patients from harm by investing in dedicated COVID-19 free hospital areas. These can be tailored to the resources available locally, ensuring that patients treated for COVID-19 are not mixed with patients needing surgery.”

“However, this represents a significant challenge to many hospitals around the world. Governments and hospital providers must help to fund this major international redesign of surgical services and provide protection for patients. COVID-19 free areas could save many lives during future waves, by allowing surgery to continue safely despite high rates of infection in the community,” he added.

Data included represented a wide variety of different surgeries for patients of all ages, genders and ethnicities. The study covered adult patients undergoing elective surgery with curative intent for a range of suspected cancers including bowel, gullet, stomach, head and neck, lung, liver, pancreas, bladder, prostate, kidney, womb, cervix, ovarian, breast, sarcoma and brain tumours.

Major reorganisation of hospital services to provide COVID-19 free areas for elective surgery must be justified by evidence like this, as it redirects time and resources away from other services. We have proved that those efforts are essential in protecting patients undergoing surgery during the pandemic.” said James Glasbey, co-lead author and doctoral research fellow at the University of Birmingham. “Our data showed that COVID-19 free hospital areas were beneficial when the rate of infection in the community was both low and high. We recommend that COVID-19 free areas are set-up in all countries currently affected by the pandemic, including those likely to suffer from future waves,” he continued.

However, he also acknowledged that “overcoming the challenges of setting up such pathways, including separate hospitals to provide elective surgery, may lead to unintended consequences. Consequences for hospitals must be carefully monitored to achieve the best balance of healthcare for patients.”

The study, titled “Elective cancer surgery in COVID-19 free surgical pathways during the SARS-CoV-2 pandemic: An international, multicentre, comparative cohort study was published online on 6 October 2020 in the Journal of Clinical Oncology.

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