Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study
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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DOI：
10.1200/jco.20.01933
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发表时间：
2021-01-01
影响因子：
45.3
通讯作者：
Testa, V
中科院分区：
文献类型：
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作者：
Glasbey, James C.;Nepogodiev, Dmitri;Testa, V
随着癌症手术在第一波COVID-19疫情后重新开始，医疗保健提供者迫切需要数据来确定在哪里进行择期手术最好。本研究旨在确定无COVID-19手术路径与无明确路径的医院相比是否与较低的术后肺部并发症发生率相关。患者和方法这项国际多中心队列研究纳入了术前未怀疑SARS-CoV-2的10种实体癌类型的择期手术患者。参与医院包括当地出现SARS-CoV-2的患者，直到2020年4月19日。在手术时，医院被定义为具有无COVID-19手术路径（手术室、重症监护和住院病房区域完全隔离）或没有定义的路径（不完全隔离或没有隔离，与COVID-19患者共享区域）。主要结局为术后30天肺部并发症（肺炎、急性呼吸窘迫综合征、非预期通气）。在来自55个国家447家医院的9，171名患者中，有2，481名患者在无COVID-19的手术路径中接受了手术。在无COVID-19手术路径内接受手术的患者比在无明确路径但大手术比例相似的医院接受手术的患者更年轻，合并症更少。调整后，无COVID-19手术路径的肺部并发症发生率较低（2.2% vs 4.9%;调整后比值比[aOR]，0.62; 95% CI，0.44至0.86）。这与低风险患者（美国麻醉医师协会1/2级）、倾向评分匹配模型和SARS-CoV-2术前检测阴性患者的敏感性分析一致。无COVID-19手术路径的术后SARS-CoV-2感染率也较低（2.1% vs 3.6%; aOR，0.53; 95%CI，0.36至0.76）。结论在现有资源范围内，应建立专门的无COVID-19手术路径，以在当前和未来SARS-CoV-2爆发之前提供安全的择期癌症手术。
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.