NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom.
University of Birmingham, Birmingham, United Kingdom.
J Clin Oncol. 2021 Jan 1;39(1):66-78. doi: 10.1200/JCO.20.01933. Epub 2020 Oct 6.
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.
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).
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% 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% 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76).
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.
随着第一波 COVID-19 疫情过后癌症手术的重新开展，医疗保健提供者迫切需要数据来确定在哪里进行选择性手术最佳。本研究旨在确定与没有明确途径的医院相比，无 COVID-19 手术途径是否与较低的术后肺部并发症发生率相关。
这项国际多中心队列研究纳入了 10 种实体癌类型的择期手术患者，术前无 SARS-CoV-2 感染的可疑迹象。参与研究的医院包括当地出现 SARS-CoV-2 直至 2020 年 4 月 19 日的患者。在手术时，医院被定义为有无 COVID-19 手术途径（手术室、重症监护病房和住院病房区域完全隔离）或无明确途径（隔离不完整或无隔离，与 COVID-19 患者共用区域）。主要结局为 30 天术后肺部并发症（肺炎、急性呼吸窘迫综合征、意外通气）。
在来自 55 个国家的 447 家医院的 9171 名患者中，有 2481 名患者在无 COVID-19 手术途径下进行了手术。与无明确途径的医院相比，接受无 COVID-19 手术途径的患者年龄较小，合并症较少，但主要手术比例相似。调整后，无 COVID-19 手术途径的肺部并发症发生率较低（2.2%比 4.9%；调整后的优势比 [aOR]，0.62；95%CI，0.44 至 0.86）。在低风险患者（美国麻醉医师协会分级 1/2）、倾向评分匹配模型和术前 SARS-CoV-2 检测阴性的患者中，敏感性分析结果一致。无 COVID-19 手术途径的术后 SARS-CoV-2 感染率也较低（2.1%比 3.6%；aOR，0.53；95%CI，0.36 至 0.76）。
在现有资源范围内，应建立专门的无 COVID-19 手术途径，以在当前和未来 SARS-CoV-2 爆发期间提供安全的择期癌症手术。
