COVID-free hospital zones could prevent cancer surgery complications, deaths: study

The results of an international study suggest that having “COVID-19-free” areas in hospitals could prevent tens of thousands of surgical patients from experiencing complications or death in Canada alone.

Researchers looked at data from 9,171 patients undergoing elective cancer surgery in 55 countries, including Canada, from the start of the coronavirus pandemic to the middle of April 2020, and discovered that complications and deaths after surgery were lower for patients whose treatment took place in so-called COVID-free areas.

At the same time, the study found only 27 per cent of patients were cared for in these protected areas.

“What that would mean is that patients coming in for surgery — whether it’s for their pre-admit screening or through the operating room and then travelling through to the recovery area or the intensive care unit or the recovery ward — it means that all of that full pathway needs to be free and separate from any contact with COVID,” explained Janet Martin of Western University in London, Ont.

“That means that it’s a very intentional COVID-free pathway specifically designed for surgical patients who we know are at higher risk of adverse events if they come in contact with COVID around the time of their surgery.”

Martin, who is part of the CovidSurg Collaborative involving researchers around the world, says having that pathway reduced risks by about half. According to the data, pulmonary complications for those in COVID-19-free zones were documented at rates of 2.2 per cent compared to 4.9 per cent otherwise, the rates of contracting COVID-19 around the time of surgery were 2.1 per cent versus 3.6 per cent, and the rates of death after surgery were 0.7 per cent compared to 1.7 per cent.

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“Because of that magnitude of reduction in risk, we’re suggesting that it is worth the time and the resources to intentionally set up this COVID-free pathway in order to spare that risk for our surgical patients.”

Martin noted that what resources are needed to create such a pathway would differ from hospital to hospital.

“In this particular global study, the majority of the hospitals that achieve this COVID-free pathway had done it within the four walls of their hospital where they may also be treating COVID patients but they created a pathway that was COVID-free, separated either by existing barriers or temporary barriers put up so that there was no mixing of patients within the same hospital where COVID patients might be presenting to the emerge department or being treated in the wards or the ICU,” she explained.

“Now that this study has been released, there’s going to be quite a lot of activity in the coming days in order to clarify, how do you actually set up a COVID-free pathway in a hospital where COVID itself might be presenting? Very few hospitals or cities were able to separate COVID in one hospital vs. COVID-free in another hospital, which might be within the same city limits, but that was a less common scenario.”

Researchers say more than 300-million surgeries take place worldwide every year and having a COVID-19-free pathway in every hospital could prevent millions of serious complications and deaths.

The CovidSurg Collaborative is led by researchers at the University of Birmingham in the United Kingdom and consists of experts from over 130 countries.

“As health providers restart 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 patients treated for COVID-19 are not mixed with patients needing surgery,” said CovidSurg Collaborative lead Dr. Aneel Bhangu with the University of Birmingham.

The study involved adult patients undergoing elective surgery for a range of cancers including: bowel, esophagus, stomach, head and neck, lung, liver, pancreas, bladder, prostate, kidney, uterine, cervix, ovarian, breast, sarcoma and brain tumours.

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