The impact of COVID-19 on surgical outcomes – a first report from the South East London (SEL) Cancer Surgery Hub


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Beth Russell, Harvey Dickinson, Graham Roberts, Charlotte Moss, Gincy George, Sophie Irwin, Jonathan Olsburgh, Jain Urvashi, Francesca Cocco, Sarah McCrindle, Aina Brunet, Ricard Simo, Parthi Srinivasan, Andreas Prachailias, Rujun Ma, Jenny Geh, Stephanie Fraser, Ella Doerge, Ben Challacombe, Marios Hadjipavlou, Rosaria Scarpinata, Paolo Sorelli, Saoirse Dolly, Mieke Van Hemelrijck, Kate Haire

Abstract

Background

The SEL Cancer Surgery Hub was established to provide a COVID19-minimal pathway for patients requiring time-critical cancer surgery. Patients were prioritised based on the framework agreed by network key stakeholders. Patients were required to self-isolate (shield) for 14 days and be swabbed for Covid-19 on day of admission, a minimum of 24 hours before surgery. Patients with a positive swab had surgery deferred.

Method

The Cancer Alliance and surgical leads collected demographic, surgical and outcome data on all patients referred to the cancer surgical hub.  The immediate aim to evaluate outcomes of cancer surgical patients by quantifying COVID-19 infection rate post-operatively and at 30 days post-discharge. A further aim was to understand mortality and morbidity and the wider the impact of COVID-associated delay on cancer outcomes. Here, we report on the validate data for the first three months (April-June 2020; n=732).

Results

Median age was 60 years. The majority of patients were white (74%); 16% black, 3% Asian and 8% of mixed ethnic backgrounds. 21% underwent thoracic surgery (n=154) followed by 21% breast (n=152), 18% urological (n=129), colorectal (9%), gynaecology (8%), head and neck (9%), liver (8%), plastics (2%), and upper gastrointestinal surgery (3%). No patient was COVID-19 swab positive at 30 days. 35 patients developed complications (5%) and 7 patients (<1%) were readmitted. Median length of stay was 4 days (range 0-57). Two patients have  died following their surgery (<1%).

Conclusion

The SEL Cancer Surgery Hub outcomes demonstrate we provided safe  cancer surgery during the peak of the COVID-19 pandemic. Our COVID-19 minimal pathway was robust with no post-operative COVID-19 cases. There were low complication and readmission rates as well as low 30-day mortality. We plan to use this data to inform planning of the surgical cancer pathway in the event of a second COVID-19 wave, whilst evaluating variation in access and outcomes across demographics and tumour types. Additionally, we aim to understand the impact of delayed surgery on longer-term oncological outcomes.

Impact statement

The SEL Cancer Surgery Hub outcomes demonstrate a safe high-quality cancer surgery pathway during the peak of the COVID-19 pandemic with minimal complications and no COVID-19 infections post-surgery.