Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Sci Rep. 2023 Aug 18;13(1):13432. doi: 10.1038/s41598-023-40264-9.
To mitigate COVID-19-related shortage of treatment capacity, the hepatopancreatobiliary (HPB) unit of the Royal Free Hospital London (RFHL) transferred its practice to independent hospitals in Central London through the North Central London Cancer Alliance. The aim of this study was to critically assess this strategy and evaluate perioperative outcomes. Prospectively collected data were reviewed on all patients who were treated under the RFHL HPB unit in six hospitals between November 2020 and October 2021. A total of 1541 patients were included, as follows: 1246 (81%) at the RFHL, 41 (3%) at the Chase Farm Hospital, 23 (2%) at the Whittington Hospital, 207 (13%) at the Princess Grace Hospital, 12 (1%) at the Wellington Hospital and 12 (1%) at the Lister Hospital, Chelsea. Across all institutions, overall complication rate were 40%, major complication (Clavien-Dindo grade ≥ 3a) rate were 11% and mortality rates were 1.4%, respectively. In COVID-19-positive patients (n = 28), compared with negative patients, complication rate and mortality rates were increased tenfold. Outsourcing HPB patients, including their specialist care, to surrounding institutions was safe and ensured ongoing treatment with comparable outcomes among the institutions during the COVID-19 pandemic. Due to the lack of direct comparison with a non-pandemic cohort, these results can strictly only be applied within a pandemic setting.
为缓解与 COVID-19 相关的治疗能力短缺问题，伦敦皇家自由医院（RFHL）的肝胆胰（HPB）科室通过北伦敦癌症联盟将其业务转移到伦敦市中心的独立医院。本研究旨在对此策略进行严格评估，并评估围手术期结果。对 2020 年 11 月至 2021 年 10 月期间在六家医院接受 RFHL HPB 科室治疗的所有患者的前瞻性收集数据进行了回顾。共纳入 1541 例患者，其中 1246 例（81%）在 RFHL，41 例（3%）在 Chase Farm 医院，23 例（2%）在 Whittington 医院，207 例（13%）在 Princess Grace 医院，12 例（1%）在 Wellington 医院，12 例（1%）在切尔西的 Lister 医院。在所有机构中，总体并发症发生率为 40%，主要并发症（Clavien-Dindo 分级≥3a）发生率为 11%，死亡率为 1.4%。在 COVID-19 阳性患者（n=28）中，与阴性患者相比，并发症发生率和死亡率增加了十倍。将 HPB 患者（包括其专科护理）外包给周边机构是安全的，并确保了在 COVID-19 大流行期间各机构之间的持续治疗和可比结果。由于缺乏与非大流行队列的直接比较，这些结果仅在大流行环境中严格适用。
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