Surgical Outcomes in Cancer Patients Undergoing Elective Surgery After Recovering from Mild-to-Moderate SARS-CoV-2 Infection.

BACKGROUND: An increasing number of patients with cancer diagnoses and prior SARS-CoV-2 infection will require surgical treatment. The objective of this study was to determine whether a history of SARS-CoV-2 infection increases the risk of adverse postoperative events following surgery in patients with cancer. METHODS: This was a propensity-matched cohort study from April 6, 2020 to October 31, 2020 at the UT MD Anderson Cancer Center. Cancer patients were identified who underwent elective surgery after recovering from SARS-CoV-2 infection and matched to controls based on patient, disease, and surgical factors. Primary study outcome was a composite of the following adverse postoperative events that occurred within 30 days of surgery: death, unplanned readmission, pneumonia, cardiac injury, or thromboembolic event. RESULTS: A total of 5682 patients were included for study, and 114 (2.0%) had a prior SARS-CoV-2 infection. The average time from infection to surgery was 52 (range 20-202) days. Compared with matched controls, there was no difference in the rate of adverse postoperative outcome (14.3% vs. 13.4%, p = 1.0). Patients with a SARS-CoV-2-related inpatient admission before surgery had increased odds of postoperative complication (adjusted odds ratio [aOR] 7.4 [1.6-34.3], p = 0.01). CONCLUSIONS: A minimal wait time of 20 days after recovering from minimally symptomatic SARS-CoV-2 infection appears to be safe for cancer patients undergoing low-risk elective surgery. Patients with SARS-CoV-2 infections requiring inpatient treatment were at increased risk for adverse events after surgery. Additional wait time may be required in those with more severe infections.

Multidisciplinary Approach to Reduce OR Delay and Cancellations Due to Covid-19 Testing

The COVID-19 pandemic has influenced the global health care system. The institutional guidelines indicate that all surgical procedures require a negative COVID test within four days of surgery. Operating room (OR) delays/cancellations related to pending COVID results can lead to unnecessary waste of PPE resources. Additionally, it can cause undue emotional distress for the patient and family, which affects the patient experience. The objective of this project was to reduce OR delays/cancellations related to COVID-19 testing. Perioperative guidelines and workflow on testing for COVID-19 prior to surgery was developed utilizing the institutional guidelines, based on Centers for Disease Control and Prevention (CDC) recommendations. A tracking tool was created to enter COVID-19 test information, starting from 6/15/2020. This data included information regarding test status, delays and cancellations. Testing appointments and pending results were reviewed throughout the day to ensure timely identification and interventions if the patients fell outside the COVID testing criteria. Communication to surgical and leadership teams were also completed to ensure proper follow up and escalation of processes. The development of a COVID-19 test tracking tool data indicates significant reduction of OR delay or cancellation. The overall data from June to August 2020 shows that COVID-19 pending tests have improved significantly from 6.8% to 0.2%. Of the pending results, the delay of surgical cases improved from 2.9% to 0.2%;and the cancellations of cases improved from 0.7% to 0.07%. Having a tracking tool provides perianesthesia nurses an opportunity to quickly identify COVID testing needs. This can have a positive impact on the patient experience during a pandemic and eliminate the waste of PPE, helping the organization to be financially responsible. The development of the perioperative guidelines is important in managing practice changes during a global pandemic.

Modified PACU Discharge Process During COVID-19 Pandemic

Coronavirus disease-2019 (COVID-19) has become a worldwide pandemic that presented challenges and brought extensive changes in the healthcare delivery. Restricting visitation in peri-operative setting is one of the steps adapted by the institution to enhance safety of patients, families and healthcare workers. This had a great impact on the discharge process in the Post-anesthesia Care Unit (PACU). Implement a modified discharge process to ensure safe transfer and continuation of care of post-operative patients. Visitor's restriction led to no visitors in perioperative setting except for pediatrics and patients with physical / cognitive limitations. This new process demanded a modified discharge process for outpatients. The two methods used were: • Virtual instruction: Given to family or responsible person by phone before discharging patients from PACU. • Face-to-Face discharge instruction: Provided in one of the four temporary discharge centers created at the entrance to minimize visitation time and exposure to other patients in PACU. Patient families who required one- on -one demonstration and practice identified and escorted to discharge center after COVID screening. Prescriptions for all patients delivered by pharmacy. Copy of after visit summary and patient education provided to family and included in electronic medical record. Successfully implemented the modified PACU discharge workflow in April 2020. Data collected from 4/1/20 to 1/31/2021 shows that 7,409 patients used the modified discharge process. Out of the 7,409, 86% received instruction through phone call and 14% used the discharge center. Press Ganey patient satisfaction rate with discharge remained high at 96%. This project demonstrated the importance of adapting new process to enable safe delivery of care during emergencies. The modified workflow allowed effective transfer of discharge information and patient education for PACU patients while following COVID-19 protocol for visitation. This new model of discharge process can be replicated in similar healthcare environment.

Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience.

OBJECTIVE: To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave. SUMMARY OF BACKGROUND DATA: The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years. METHODS: The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients. RESULTS: We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. CONCLUSIONS: Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.