ABSTRACT
OBJECTIVE: The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic. SUMMARY OF BACKGROUND DATA: Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a "COVID-minimal pathway" was created. METHODS: Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The "COVID-minimal surgical pathway" consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections. RESULTS: After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56-79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1-6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection. CONCLUSIONS: A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.
Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Critical Pathways/organization & administration , Cross Infection/prevention & control , Emergency Treatment , SARS-CoV-2 , Safety Management/organization & administration , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative , Aged , COVID-19/epidemiology , Female , Humans , Male , Middle AgedABSTRACT
Patients with COVID-19 are at risk of developing acute respiratory distress syndrome requiring invasive mechanical ventilation. Barotrauma in these patients often leads to clinically significant pneumothorax, which necessitates chest tube thoracostomy. However, given the mode of transmission of the severe acute respiratory syndrome coronavirus 2 virus and the aerosolizing nature of the procedure, special considerations and care must be taken to mitigate the exposure risks to health care personnel. This article discusses the risk mitigation strategies proposed and under review at the authors' institution.