Consultant Plastic and Reconstructive Surgeon, University Hospitals of Leicester, UK; University of Manitoba, Winnipeg, Canada; Department of Plastic and Reconstructive Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK.
Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
J Plast Reconstr Aesthet Surg. 2021 Jun;74(6):1161-1172. doi: 10.1016/j.bjps.2020.12.032. Epub 2020 Dec 13.
The safety of surgery during and after the coronavirus disease-2019 (COVID-19) pandemic is paramount. Early reports of excessive perioperative mortality in COVID-positive patients promoted the widespread avoidance of operations. However, cancelling or delaying operations for cancer, trauma, or functional restitution has resulted in increased morbidity and mortality.
A national multicentre cohort study of all major reconstructive operations carried out over a 12-week period of the 'COVID-19 surge' in the United Kingdom and Ireland was performed. Primary outcome was 30-day mortality and secondary outcome measures were major complications (Clavien-Dindo grade ≥3) and COVID-19 status of patients and healthcare professionals before and after surgery.
A total of 418 patients underwent major reconstructive surgery with a mean operating time of 7.5 hours and 12 days' inpatient stay. Cancer (59.8%) and trauma (29.4%) were the most common indications. COVID-19 infection was present in 4.5% of patients. The 30-day post-operative mortality was 0.2%, reflecting the death of one patient who was COVID-negative. Overall complication rate was 20.8%. COVID status did not correlate with major or minor complications. Eight healthcare professionals developed post-operative COVID-19 infection, seven of which occurred within the first three weeks.
Major reconstructive operations performed during the COVID-19 crisis have been mostly urgent cases involving all surgical specialties. This cohort is a surrogate for all major operations across all surgical specialties. Patient safety and surgical outcomes have been the same as in the pre-COVID era. With adequate precautions, major reconstructive surgery is safe for patients and staff. This study helps counsel patients of COVID-19 risks in the perioperative period.
在 2019 年冠状病毒病（COVID-19）大流行期间和之后，手术的安全性至关重要。早期关于 COVID-19 阳性患者围手术期死亡率过高的报告促使广泛避免手术。然而，取消或延迟癌症、创伤或功能恢复的手术导致发病率和死亡率增加。
对英国和爱尔兰 COVID-19 高峰期的 12 周内进行的所有主要重建手术进行了一项全国多中心队列研究。主要结局是 30 天死亡率，次要结局指标是患者和医护人员手术前后的主要并发症（Clavien-Dindo 分级≥3）和 COVID-19 状态。
共有 418 例患者接受了主要重建手术，平均手术时间为 7.5 小时，住院时间为 12 天。癌症（59.8%）和创伤（29.4%）是最常见的适应证。4.5%的患者存在 COVID-19 感染。术后 30 天死亡率为 0.2%，反映了一名 COVID-19 阴性患者的死亡。总并发症发生率为 20.8%。COVID 状态与主要或次要并发症无关。8 名医护人员发生术后 COVID-19 感染，其中 7 例发生在前三周内。
在 COVID-19 危机期间进行的主要重建手术大多是紧急情况，涉及所有外科专业。本队列是所有外科专业所有主要手术的替代指标。患者安全和手术结果与 COVID-19 前时代相同。只要采取适当的预防措施，主要重建手术对患者和工作人员都是安全的。本研究有助于为围手术期的 COVID-19 风险向患者提供咨询。
