Results of a new study from the COVIDSurg Collaborative, an international group of surgeons and anesthetists seeking to understand the outcomes of patients who undergo surgery in the context of coronavirus disease 2019 (COVID-19), revealed that pulmonary complication rates, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates, and mortality rates were consistently lower for patients who underwent elective cancer surgery within COVID-19–free surgical pathways compared with patients who did not. These findings, which justify the difficulty and expense to establish such pathways, were published in the Journal of Clinical Oncology.
Establishing elective operating room, critical care, and inpatient ward areas in hospitals that are not shared with patients with COVID-19 may be difficult and carry additional costs. Thus, to inform clinical practice, the international COVIDSurg Collaborative (ClinicalTrials.gov Identifier: NCT04384926), investigated whether elective cancer surgery in COVID-19–free surgical pathways are associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. The primary outcome was 30-day postoperative pulmonary complications, including pneumonia, acute respiratory distress syndrome, and unexpected ventilation.
At 447 hospitals in 55 countries, 9171 patients underwent elective surgery for 10 solid cancer types and did not have preoperative suspicion of SARS-CoV-2 infection. About 27% of patients (2481/9171) underwent surgery in COVID-19–free surgical pathways. These patients were younger and with fewer comorbidities than those in hospitals with no defined pathway.
After adjusting for differences between the groups, the pulmonary complication rates were lower in patients who underwent surgery in COVID-19–free surgical pathways (2.2%) compared with patients who underwent surgery in hospitals with no defined pathway (4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44-0.86). As expected, the postoperative SARS-CoV-2 infection rate was lower in patients who underwent surgery in COVID-19–free surgical pathways (2.1%) compared with those who underwent surgery in hospitals with no defined pathway (3.6%; aOR, 0.53; 95% CI, 0.36-0.76).
Limitations of the study included the potential for hospitals with COVID-19–free surgical pathways to have better resources and residual bias. Some patients could have been incorrectly diagnosed with SARS-CoV-2. Patients with high-risk and border-line operable cancers may not have been offered surgery, and there may have incomplete case ascertainment.
The authors concluded, “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.”
Glasbey JC, Bhangu A, COVIDSurg Collaborative. Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: an international, multicenter, comparative cohort study. J Clin Oncol. Published online October 6, 2020. doi:10.1200/JCO.20.01933