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1.
British Journal of Anaesthesia ; 128(6):909-911, 2022.
Article in English | Web of Science | ID: covidwho-2011447

ABSTRACT

Current or recent infection with SARS-CoV-2 increases the risk of perioperative morbidity and mortality. Consensus guidelines recommend delaying elective major surgery after acute SARS-CoV-2 infection for 7 or 8 weeks. However, because of the growing backlog of untreated surgical disease and the potential risks of delaying surgery, surgical services may be under pressure to reduce this period. Here, we discuss the risks and benefits of delaying surgery for patients with current or recent SARS-CoV-2 infection in the context of the evolving COVID-19 pandemic, the limited evidence supporting delays to surgery, and the need for more research in this area.

2.
Br J Anaesth ; 127(2): 205-214, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275162

ABSTRACT

BACKGROUND: The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated mortality after surgery. METHODS: Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI). RESULTS: We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 [21.4%] vs no SARS-CoV-2: 20 211/2 638 201 [0.8%]; OR=5.7 [95% CI, 5.5-5.9]; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR=25.8 [95% CI, 21.7-30.9]; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR=5.5 [95% CI, 5.3-5.7]; P<0.001). CONCLUSIONS: The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.


Subject(s)
COVID-19/mortality , COVID-19/surgery , Elective Surgical Procedures/mortality , Elective Surgical Procedures/trends , Hospital Mortality/trends , Population Surveillance , Adult , Aged , Aged, 80 and over , England/epidemiology , Epidemiologic Studies , Female , Humans , Male , Middle Aged , Population Surveillance/methods
3.
Br J Surg ; 108(1): 97-103, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1104800

ABSTRACT

BACKGROUND: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. METHODS: This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. RESULTS: A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. CONCLUSION: As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.


Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/economics , Elective Surgical Procedures/statistics & numerical data , Hospital Costs , Pandemics , COVID-19/diagnosis , COVID-19 Testing , England/epidemiology , Facilities and Services Utilization/economics , Hospitalization/statistics & numerical data , Humans , Models, Statistical , Personal Protective Equipment , Preoperative Care , SARS-CoV-2 , Time-to-Treatment/economics
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