Elective cancer surgery in COVID-19-free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study Journal Article

Authors: Glasbey, J. C.; Nepogodiev, D.; Simoes, J. F. F.; Omar, O.; Li, E.; Venn, M. L.; Abou Chaar, M. K.; Capizzi, V.; Chaudhry, D.; Desai, A.; Edwards, J. G.; Evans, J. P.; Fiore, M.; Videria, J. F.; Ford, S. J.; Ganly, I.; Griffiths, E. A.; Gujjuri, R. R.; Kolias, A. G.; Kaafarani, H. M. A.; Minaya-Bravo, A.; McKay, S. C.; Mohan, H. M.; Roberts, K. J.; Miguel-Méndez, C. S.; Pockney, P.; Shaw, R.; Smart, N. J.; Stewart, G. D.; Sundar, S.; Vidya, R.; Bhangu, A. A.; on behalf of the COVIDSurg Collaborative
Contributor: Brown, L.
Article Title: Elective cancer surgery in COVID-19-free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study
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. Copyright © 2020 American Society of Clinical Oncology. All rights reserved.
Keywords: adult; aged; middle aged; cancer surgery; major clinical study; advanced cancer; comparative study; pancreas cancer; preoperative care; cancer staging; colorectal cancer; disease association; breast cancer; cohort analysis; age; pneumonia; sarcoma; postoperative complication; intensive care unit; preoperative period; head and neck cancer; cardiovascular risk; comorbidity; urinary tract cancer; postoperative infection; surgical mortality; stomach cancer; major surgery; liver cancer; brain cancer; sex difference; esophagus cancer; biliary tract cancer; adult respiratory distress syndrome; elective surgery; stomach surgery; lung complication; female genital tract cancer; pandemic; infection rate; esophagus surgery; low risk patient; very elderly; human; male; female; priority journal; article; ward; coronavirus disease 2019; covid-19 testing
Journal Title: Journal of Clinical Oncology
Volume: 39
Issue: 1
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2021-01-01
Start Page: 66
End Page: 78
Language: English
DOI: 10.1200/jco.20.01933
PUBMED: 33021869
PROVIDER: scopus
PMCID: PMC8189635
Notes: Article -- Export Date: 1 February 2021 -- Source: Scopus
Citation Impact
MSK Authors
  1. Ian Ganly
    317 Ganly
  2. Lauren Terese Brown
    2 Brown