Boffa Daniel J, Judson Benjamin L, Billingsley Kevin G, Del Rossi Erin, Hindinger Kasey, Walters Samantha, Ermer Theresa, Ratner Elena, Mitchell Marci R, Laurans Maxwell S, Johnson Dirk C, Yoo Peter S, Morton John M, Zurich Holly B, Davis Kimberly, Ahuja Nita
Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut.
Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Ann Surg. 2020 Dec;272(6):e316-e320. doi: 10.1097/SLA.0000000000004455.
The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic.
Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a "COVID-minimal pathway" was created.
Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The "COVID-minimal surgical pathway" consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections.
After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56-79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1-6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection.
A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.
在新型冠状病毒肺炎（COVID-19）住院人数激增期间，评估采用COVID-19最小化路径治疗的患者的治疗结果，以确定在疫情期间继续进行急诊手术的安全性。
在COVID-19大流行期间，由于担心医院获得性COVID-19感染，许多患者的关键治疗被推迟。为了保护那些生存依赖于及时手术的癌症患者，创建了一条“COVID-19最小化路径”。
对2020年4月至5月期间在该路径上接受手术的患者进行评估。“COVID-19最小化手术路径”包括：（A）不断发展的减少COVID-19传播的最佳实践；（B）对患者和工作人员进行筛查；（C）术前对COVID-19患者进行检测；（D）将路径上的患者与COVID-19患者隔离。确定出院后2周内的患者状态，以反映医院获得性COVID-19感染情况。
实施后，路径筛查程序排除了7名COVID-19阳性人员与该路径的接触（4名工作人员和3名患者）。总体而言，122名患者在该路径上接受了125例手术，产生了83次入院（42例门诊手术）。中位年龄为64岁（56-79岁），57%的患者为女性。最常见的手术指征是影响子宫、泌尿生殖道、结肠、肺或头颈部的癌症。中位住院时间为3天（1-6天）。对27名患者进行了重复COVID-19检测（均为阴性），包括9名在急诊室评估的患者和8名再次入院的患者。在术后期间，没有患者发生COVID-19感染。
由物理空间改造和操作改变组成的COVID-19最小化路径可能允许在COVID-19大流行期间，甚至在激增阶段，安全地继续进行紧急癌症治疗。
