Is a 'COVID-19-free' hospital the answer to resuming elective surgery during the current pandemic? Results from the first available prospective study

Background Resumption of elective surgery during the current Coronavirus disease 2019 (COVID-19) pandemic crisis has been debated widely and largely discouraged. The aim of this prospective cohort study was to assess the feasibility of resuming elective operations during the current and possible future peaks of this COVID-19 pandemic. Methods We collected data during the peak of the current pandemic in the United Kingdom on adult patients who underwent elective surgery in a ‘COVID-19 free’ hospital from 8th April to 29th May 2020. The study included patients from various surgical specialities. Non-elective and pediatric cases were excluded. The primary outcome was 30-day mortality post operatively. Secondary outcomes were the rate of COVID-19 infections, new onset of pulmonary symptoms after hospitalisation, and requirement for admission to the Intensive Care Unit (ICU). Results A total of 309 consecutive adult patients were included in this study. No patients died nor required ICU admission. Operations graded ‘Intermediate’ were the most commonly performed procedure representing 91% of the total number. One patient was diagnosed with COVID-19 infection after being transferred to the nearest local emergency hospital for management of post-operative pain secondary to common bile duct stone and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. 27 patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo’ classification occurred in 14 and 2 patients, respectively. Conclusions This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 (SARS-CoV-2) disease, ‘COVID-19 free’ hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic.
Highlights This is the first prospective data on resumed elective surgery performed in a ‘COVID-19 free’ hospital. The importance of this study is that, despite the severity and high transmissibility of SARS-CoV-2 disease, ‘COVID-19 free’ hospitals in the independent sector represent a safe setting to resume elective surgery during the peak of a pandemic.