RACS calls for COVID-19 free hospital areas for elective surgery

MedTech News: Setting up ‘COVID-19 free’ hospital areas for surgical patients could save lives during the additional waves of the pandemic, reducing the risk of death from lung infections associated with coronavirus, a new global study reveals.

Researchers working together around the world found that that patients who had their operation and hospital care in ‘COVID-19 free’ areas had better outcomes. ‘COVID-19 free’ areas improved the safety of surgery by having a strict policy that no patients treated for COVID-19 were mixed with those undergoing surgery. ‘COVID-19 free areas’ were set up both in smaller independent hospitals and large hospitals with emergency departments.

For fear that patients may contract COVID-19 in hospital, millions of operations around the world were cancelled during the first wave of the pandemic. As subsequent waves affect countries, including Australia, more patients face delays. When operations for cancer and other time-dependent conditions are delayed, they can progress to be untreatable.

This research has shown, for the first time, that hospitals around the world can continue safe surgery by setting up COVID-19 free areas to minimise the risk from the coronavirus.

Researchers examined data from 9,171 patients in 55 countries, across five different continents from the start of the pandemic up the middle of April 2020. Experts have discovered that pulmonary (lung) complication (2.2% vs 4.9%) and rates of death after surgery (0.7% vs 1.7%) were lower for patients who had their hospital treatment in ‘COVID-19 free’ areas.  However, in this study, just 27% of patients had their care in these protected areas.

It is estimated that around 55,000 operations take place each year in Australia for the five most common surgically treated cancers (breast, prostate, colorectal, lung and melanoma). Setting up COVID-19 free hospital areas could protect these patients from this risk, and allow safer surgery to continue, even if the virus infection rises again in one or more of our major cities.

Led by researchers at the University of Birmingham, the COVIDSurg Collaborative comprises of experts from over 130 countries. The group has published its findings in the Journal of Clinical Oncology, which is a leading global cancer research journal. Data from Australia was collected by more than 100 trainees and Fellows from the Royal Australasian College of Surgeons (RACS).

Collaborative lead in Australia, Consultant Surgeon and Royal Australasian College of Surgeons Fellow, Dr Peter Pockney, from the University of Newcastle, NSW, commented “As health providers provide elective cancer surgery, they must look to protect cancer surgery patients from harm by investing in dedicated COVID-19 free hospital areas. These can be tailored to the resources available locally, ensuring that patients treated for COVID-19 are not mixed with patients needing surgery.

“However, this represents a significant challenge to the hospital system around the country. Governments and hospital providers must help to fund this major redesign of surgical services if and when the virus affects us again and provide protection for patients. COVID-19 free areas could save many lives during future waves, by allowing surgery to continue safely despite high rates of infection in the community.”

The study was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant. It covered adult patients undergoing elective surgery with curative intent for a range of suspected cancers including bowel, gullet, stomach, head and neck, lung, liver, pancreas, bladder, prostate, kidney, womb, cervix, ovarian, breast, sarcoma and brain tumours.

Dr Nagendra Dudi-Venkata, a Royal Australasian College of Surgeons (RACS) surgical trainee and study leader in South Australia, commented “Major reorganisation of hospital services to provide COVID-19 free areas for elective surgery must be justified by evidence like this, as it redirects time and resources away from other services. We have proved that those efforts are essential in protecting patients undergoing surgery during the pandemic.

“Our data showed that COVID-19 free hospital areas were beneficial when the rate of infection in the community was both low and high. We recommend that COVID-19 free areas are set-up in all countries currently affected by the pandemic, including those likely to suffer from future waves.

“However, overcoming the challenges of setting up such pathways, including separate hospitals to provide elective surgery, may lead to unintended consequences. Consequences for hospitals must be carefully monitored to achieve the best balance of healthcare for patients.”