ABSTRACT
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.
Subject(s)
COVID-19/prevention & control , Critical Care/methods , Elective Surgical Procedures/methods , Neoplasms/surgery , Postoperative Complications/prevention & control , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Cohort Studies , Epidemics , Female , Humans , International Cooperation , Logistic Models , Male , Middle Aged , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Postoperative Complications/virology , SARS-CoV-2/physiologyABSTRACT
BACKGROUND: Several guidelines to guide clinical practice among esophagogastric surgeons during the COVID-19 pandemic were produced. However, none provide reflection of current service provision. This international survey aimed to clarify the changes observed in esophageal and gastric cancer management and surgery during the COVID-19 pandemic. METHODS: An online survey covering key areas for esophagogastric cancer services, including staging investigations and oncological and surgical therapy before and during (at two separate time-points-24th March 2020 and 18th April 2020) the COVID-19 pandemic were developed. RESULTS: A total of 234 respondents from 225 centers and 49 countries spanning six continents completed the first round of the online survey, of which 79% (n = 184) completed round 2. There was variation in the availability of staging investigations ranging from 26.5% for endoscopic ultrasound to 62.8% for spiral computed tomography scan. Definitive chemoradiotherapy was offered in 14.8% (adenocarcinoma) and 47.0% (squamous cell carcinoma) of respondents and significantly increased by almost three-fold and two-fold, respectively, in both round 1 and 2. There were uncertainty and heterogeneity surrounding prioritization of patients undergoing cancer resections. Of the surgeons symptomatic with COVID-19, only 40.2% (33/82) had routine access to COVID-19 polymerase chain reaction testing for staff. Of those who had testing available (n = 33), only 12.1% (4/33) had tested positive. CONCLUSIONS: These data highlight management challenges and several practice variations in caring for patients with esophagogastric cancers. Therefore, there is a need for clear consistent guidelines to be in place in the event of a further pandemic to ensure a standardized level of oncological care for patients with esophagogastric cancers.