Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study
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Published:2021-01-01
Issue:1
Volume:39
Page:66-78
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Glasbey James C.1ORCID, Nepogodiev Dmitri1, Simoes Joana F.F.1, Omar Omar1, Li Elizabeth2, Venn Mary L.3, PGDME 3, Abou Chaar Mohammad K.4, Capizzi Vita5, Chaudhry Daoud2, Desai Anant6, Edwards Jonathan G.7, Evans Jonathan P.8, Fiore Marco5, Videria Jose Flavio9, Ford Samuel J.6, Ganly Ian10, Griffiths Ewen A.11, Gujjuri Rohan R.2, Kolias Angelos G.12, Kaafarani Haytham M.A.13, Minaya-Bravo Ana14, McKay Siobhan C.15, Mohan Helen M.16, Roberts Keith J.15, San Miguel-Méndez Carlos14, Pockney Peter17, Shaw Richard18, Smart Neil J.19, Stewart Grant D.20, Sundar, MRCOG Sudha21, Vidya Raghavan22, Bhangu Aneel A.2, Glasbey James C, Nepogodiev Dmitri, Simoes Joana FF, Omar Omar, Li Elizabeth, Venn Mary L, Chaar Mohammad Abou, Capizzi Vita, Chaudhry Daoud, Desai Anant, Edwards Jonathan G, Evans Jonathan P, Fiore Marco, Videria Jose Flavio, Ford Samuel J, Ganyli Ian, Griffiths Ewen A, Gujjuri Rohan R, Kolias Angelos G, Kaafarani Haytham MA, Minaya-Bravo Ana, McKay Siobhan C, Mohan Helen M, Roberts Keith, San Miguel-Méndez Carlos, Pockney Peter, Shaw Richard, Smart Neil J, Stewart Grant D, Sundar Sudha, Vidya Raghavan, Bhangu Aneel A, Glasbey James C, Omar Omar, Bhangu Aneel A, Siaw-Acheampong Kwabena, Benson Ruth A, Bywater Edward, Chaudhry Daoud, Dawson Brett E, Evans Jonathan P, Glasbey James C, Gujjuri Rohan R, Heritage Emily, Jones Conor S, Kamarajah Sivesh K, Khatri Chetan, Khaw Rachel A, Keatley James M, Knight Andrew, Lawday Samuel, Li Elizabeth, Mann Harvinder S, Marson Ella J, McLean Kenneth A, McKay Siobhan C, Mills Emily C, Nepogodiev Dmitri, Pellino Gianluca, Picciochi Maria, Taylor Elliott H, Tiwari Abhinav, Simoes Joana FF, Trout Isobel M, Venn Mary L, Wilkin Richard JW, Bhangu Aneel A, Glasbey James C, Smart Neil J, Minaya-Bravo Ana, Evans Jonathan P, Gallo Gaetano, Moug Susan, Pata Francesco, Pockney Peter, Di Saverio Salomone, Vallance Abigail, Vimalchandran Dale, Griffiths Ewen A, Kamarajah Sivesh K, Evans Richard PT, Townend Philip, Roberts Keith, McKay Siobhan, Isaac John, Satoi Sohei, Edwards John, Coonar Aman S, Marchbank Adrian, Caruana Edward J, Layton Georgia R, Patel Akshay, Brunelli Alessandro, Ford Samuel, Desai Anant, Gronchi Alessandro, Fiore Marco, Almond Max, Tirotta Fabio, Dumitra Sinziana, Kolias Angelos, Price Stephen J, Fountain Daniel M, Jenkinson Michael D, Hutchinson Peter, Marcus Hani J, Piper Rory J, Lippa Laura, Servadei Franco, Esene Ignatius, Freyschlag Christian, Neville Iuri, Rosseau Gail, Schaller Karl, Demetriades Andreas K, Robertson Faith, Alamri Alex, Shaw Richard, Schache Andrew G, Winter Stuart C, Ho Michael, Nankivell Paul, Biel Juan Rey, Batstone Martin, Ganly Ian, Vidya Raghavan, Wilkins Alex, Singh Jagdeep K, Thekinkattil Dinesh, Sundar Sudha, Fotopoulou Christina, Leung Elaine, Khan Tabassum, Chiva Luis, Sehouli Jalid, Fagotti Anna, Cohen Paul, Gutelkin Murat, Ghebre Rahel, Konney Thomas, Pareja Rene, Bristow Rob, Dowdy Sean, Shylasree TS, Seenivasagam R Kottayasamy, Ng Joe, Fujiwara Keiiji, Stewart Grant D, Lamb Benjamin, Narahari Krishna, McNeill Alan, Colquhoun Alexandra, McGrath John, Bromage Steve, Barod Ravi, Kasivisvanathan Veeru, Klatte Tobias, Simoes Joana FF, Abbott Tom EF, Abukhalaf Sadi, Adamina Michel, Ademuyiwa Adesoji O, Agarwal Arnav, Akkulak Murat, Alameer Ehab, Alderson Derek, Alakaloko Felix, Albertsmeiers Markus, Alser Osaid, Alshaar Muhammad, Alshryda Sattar, Arnaud Alexis P, Augestad Knut Magne, Ayasra Faris, Azevedo José, Bankhead-Kendall Brittany K, Barlow Emma, Beard David, Benson Ruth A, Blanco-Colino Ruth, Brar Amanpreet, Minaya-Bravo Ana, Breen Kerry A, Bretherton Chris, Buarque Igor Lima, Burke Joshua, Caruana Edward J, Chaar Mohammad, Chakrabortee Sohini, Christensen Peter, Cox Daniel, Cukier Moises, Cunha Miguel F, Davidson Giana H, Desai Anant, Di Saverio Salomone, Drake Thomas M, Edwards John G, Elhadi Muhammed, Emile Sameh, Farik Shebani, Fiore Marco, Fitzgerald J Edward, Ford Samuel, Garmanova Tatiana, Gallo Gaetano, Ghosh Dhruv, Ataíde Gomes Gustavo Mendonça, Grecinos Gustavo, Griffiths Ewen A, Gründl Madalegna, Halkias Constantine, Harrison Ewen M, Hisham Intisar, Hutchinson Peter J, Hwang Shelley, Isik Arda, Jenkinson Michael D, Jonker Pascal, Kaafarani Haytham MA, Keller Debby, Kolias Angelos, Kruijff Schelto, Lawani Ismail, Lederhuber Hans, Leventoglu Sezai, Litvin Andrey, Loehrer Andrew, Löffler Markus W, Lorena Maria Aguilera, Modolo Maria Marta, Major Piotr, Martin Janet, Mashbari Hassan N, Mazingi Dennis, Metallidis Symeon, Minaya-Bravo Ana, Mohan Helen M, Moore Rachel, Moszkowicz David, Moug Susan, Ng-Kamstra Joshua S, Maimbo Mayaba, Negoi Ionut, Niquen Milagros, Ntirenganya Faustin, Olivos Maricarmen, Oussama Kacimi, Outani Oumaima, Parreno-Sacdalanm Marie Dione, Pata Francesco, Perez Rivera Carlos Jose, Pinkney Thomas D, van der Plas Willemijn, Pockney Peter, Qureshi Ahmad, Radenkovic Dejan, Ramos-De la Medina Antonio, Roberts Keith, Roslani April C, Rutegård Martin, Segura-Sampedro Juan José, Santos Irène, Satoi Sohei, Sayyed Raza, Schache Andrew, Schnitzbauer Andreas A, Seyi-Olajide Justina O., Sharma Neil, Shaw Richard, Shu Sebastian, Soreide Kjetil, Spinelli Antonino, Stewart Grant D, Sund Malin, Sundar Sudha, Tabiri Stephen, Townend Philip, Tsoulfas Georgios, van Ramshorst Gabrielle H, Vidya Raghavan, Vimalachandran Dale, Warren Oliver J, Wedderburn Duane, Wright Naomi, Allemand C, Boccalatte L, Figari M, Lamm M, Larrañaga J, Marchitelli C, Noll F, Odetto D, Perrotta M, Saadi J, Zamora L, Alurralde C, Caram EL, Eskinazi D, Mendoza JP, Usandivaras M, Badra R, Esteban A, García JS, García PM, Gerchunoff JI, Lucchini SM, NIgra MA, Vargas L, Hovhannisyan T, Stepanyan A, Gould T, Gourlay R, Griffiths B, Gananadha S, McLaren M, Cecire J, Joshi N, Salindera S, Sutherland A, Ahn JH, Charlton G, Chen S, Gauri N, Hayhurst R, Jang S, Jia F, Mulligan C, Yang W, Ye G, Zhang H, Ballal M, Gibson D, Hayne D, Moss J, Richards T, Viswambaram P, Vo UG, Bennetts J, Bright T, Brooke-Smith M, Fong R, Gricks B, Lam YH, Ong BS, Szpytma M, Watson D, Bagraith K, Caird S, Chan E, Dawson C, Ho D, Jeyarajan E, Jordan S, Lim A, Nolan GJ, Oar A, Parker D, Puhalla H, Quennell A, Rutherford L, Townend P, Von Papen M, Wullschleger M, Blatt A, Cope D, Egoroff N, Fenton M, Gani J, Lott N, Pockney P, Shugg N, Elliott M, Phung D, Phan D, Townend D, Bong C, Gundara J, Frankel A, Bowman S, Guerra GR, Bolt J, Buddingh K, Dudi-Venkata NN, Jog S, Kroon HM, Sammour T, Smith R, Stranz C, Batstone M, Lah K, McGahan W, Mitchell D, Morton A, Pearce A, Roberts M, Sheahan G, Swinson B, Alam N, Banting S, Chong L, Choong P, Clatworthy S, Foley D, Fox A, Hii MW, Knowles B, Mack J, Read M, Rowcroft A, Ward S, Wright G, Lanner M, Königsrainer I, Bauer M, Freyschlag C, Kafka M, Messner F, Öfner D, Tsibulak I, Emmanuel K, Grechenig M, Gruber R, Harald M, Öhlberger L, Presl J, Wimmer A, Namazov İ, Samadov E, Barker D, Boyce R, Corbin S, Doyle A, Eastmond A, Gill R, Haynes A, Millar S, O’Shea M, Padmore G, Paquette N, Phillips E, St. John S, Walkes K, Flamey N, Pattyn P, Oosterlinck W, Van den Eynde J, Van den Eynde R, Gatti A, Nardi C, Oliva R, De Cicco R, Cecconello I, Gregorio P, Pontual Lima L, Ribeiro Junior U, Takeda F, Terra RM, Sokolov M, Kidane B, Srinathan S, Boutros M, Caminsky N, Ghitulescu G, Jamjoum G, Moon J, Pelletier J, Vanounou T, Wong S, Boutros M, Dumitra S, Kouyoumdjian A, Johnston B, Russell C, Boutros M, Demyttenaere S, Garfinkle R, Abou-Khalil J, Nessim C, Stevenson J, Heredia F, Almeciga A, Fletcher A, Merchan A, Puentes LO, Mendoza Quevedo J, Bačić G, Karlović D, Kršul D, Zelić M, Luksic I, Mamic M, Bakmaz B, Ćoza I, Dijan E, Katusic Z, Mihanovic J, Rakvin I, Frantzeskou K, Gouvas N, Kokkinos G, Papatheodorou P, Pozotou I, Stavrinidou O, Yiallourou A, Martinek L, Skrovina M, Szubota I, Žatecký J, Javurkova V, Klat J, Avlund T, Christensen P, Harbjerg JL, Iversen LH, Kjaer DW, Kristensen HØ, Mekhael M, Ebbehøj AL, Krarup P, Schlesinger N, Smith H, Abdelsamed A, 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Affiliation:
1. NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom 2. University of Birmingham, Birmingham, United Kingdom 3. Queen Mary University of London, London, United Kingdom 4. King Hussein Cancer Foundation: King Hussein Cancer Center, Amman, Jordan 5. Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy 6. Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom 7. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom 8. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom 9. Francisco Gentil Portuguese Institute for Oncology of Porto: Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal 10. Memorial Sloan Kettering Cancer Center, New York, NY 11. Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom 12. Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom 13. Harvard Medical School, Centre for Outcomes & Patient Safety in Surgery, Boston, MA 14. Henares University Hospital: Hospital Universitario del Henares, Madrid, Spain 15. Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom 16. St. James Hospital, Dublin, Ireland 17. University of Newcastle, NSW, Australia 18. Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom 19. Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom 20. University of Cambridge, Cambridge, United Kingdom 21. Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, United Kingdom 22. Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
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.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
173 articles.
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