Is a "COVID-19-free" hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study
Is a "COVID-19-free" hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study
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DOI：
10.1016/j.surg.2020.07.003
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发表时间：
2020-10-01
期刊：
影响因子：
3.8
通讯作者：
Magro, Tania
中科院分区：
文献类型：
--
作者：
Gammeri, Emanuele;Cillo, Giulia Maria;Magro, Tania
背景：在当前2019冠状病毒病大流行危机期间，恢复择期手术一直存在广泛争议，但在很大程度上不受欢迎。这项前瞻性队列研究的目的是评估在2019年冠状病毒病大流行当前和未来可能出现的高峰期间恢复择期手术的可行性。方法：我们收集了2020年4月8日至5月29日在英国当前大流行高峰期在“无covid -19”医院接受择期手术的成年患者的数据。该研究包括来自不同外科专业的患者。非选择性和儿科病例被排除在外。主要终点为术后30天死亡率。次要结局是2019冠状病毒病感染率、住院后新发肺部症状和入住重症监护病房的要求。结果：本研究共纳入309例连续成人患者。没有患者死亡，也不需要进入重症监护病房。分级为“中级”的手术是执行次数最多的手术，占总数的91%。一名患者在被转移到最近的当地急救医院治疗胆总管结石术后继发疼痛后被诊断为2019冠状病毒病感染，并在病房成功进行了保守治疗。无患者出现肺部并发症。3例患者住院时间超过23小时。27例（8.7%）出现并发症。Clavien-Dindo分级2级和3级并发症分别发生14例和2例。结论：本前瞻性研究表明，尽管新型冠状病毒2的严重程度和高传播性，但在大流行高峰期，没有covid -19的医院可以代表一个安全的环境，以恢复许多类型的选择性手术。英国皇家版权所有(c) 2020 Elsevier Inc.出版版权所有。
Background: Resumption of elective surgery during the current coronavirus disease 2019 pandemic crisis has been debated widely and largely discouraged. The aim of this prospective cohort study was to assess the feasibility of resuming elective operations during the current and possible future peaks of this coronavirus disease 2019 pandemic.Methods: We collected data during the peak of the current pandemic in the United Kingdom on adult patients who underwent elective surgery in a "COVID-19-free" hospital from April 8 to May 29, 2020. The study included patients from various surgical specialties. Nonelective and pediatric cases were excluded. The primary outcome was 30-day mortality postoperatively. Secondary outcomes were the rate of coronavirus disease 2019 infections, new onset of pulmonary symptoms after hospitalization, and requirement for admission to the intensive care unit.Results: A total of 309 consecutive adult patients were included in this study. No patients died nor required intensive care unit admission. Operations graded "Intermediate" were the most performed procedure representing 91% of the total number. One patient was diagnosed with a coronavirus disease 2019 infection after being transferred to the nearest local emergency hospital for management of postoperative pain secondary to common bile duct stone and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. Twenty-seven patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo classification occurred in 14 and 2 patients, respectively.Conclusion: This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 disease, COVID-19-free hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic. Crown Copyright (c) 2020 Published by Elsevier Inc. All rights reserved.