Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of an innovative protected elective surgical unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9925 patients undergoing surgery in a university health board

ABSTRACT

Aim: The COVID-19 pandemic has caused unprecedented healthcare challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self contained Protected Elective Surgical Units (PESU) were developed to mitigate against infection related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of PESUs can result in significant reduction in risk. Method: A retrospective observational study of consecutive patients from 18 specialties, undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and PESU transmission rates. Results: Between 15th March 2020 and 14th March 2021, 9,925 patients underwent surgery, 6,464 (65.1%) elective, 5,116 (51.5%) female and median age 57 (39-70). 69.5% of all procedures were performed in PESUs. Overall, 30-day post-operative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective p<0.001). PESU post-operative transmission was significantly lower than non-PESU (0.42% vs 3.2% p<0.001), with an adjusted likely in-hospital PESU transmission of 0.04%. The 30-day all-cause mortality was 1.7%, and 14.6% in COVID-19 positive patients. COVID-19 infection, age >70, male gender, ASA >2 and emergency surgery were all independently associated with mortality. Conclusions: This study has demonstrated the value of PESUs in minimising COVID-19 viral transmission and associated mortality with additional relevance to protected elective services going forward (possibilities of reduced cancellations due to bed shortages and transmission of other nosocomial infections).