Elective surgery in times of COVID-19: A two-centre analysis of postponed operations and disease-related morbidity and mortality

Introduction: COVID-19 had an impact on the whole range of worldwide medical services. Due to the high risk of in-hospital transmission and disproportionate perioperative rates of morbidity and mortality in occult COVID-19 patients surgeons were faced with the challenging triage of surgeries into emergency, urgent and elective. The present study investigates postponed elective surgery and its impact on the medical condition of patients in two high-volume departments of general, visceral, thoracic, transplant and vascular surgery. Methods: Operations that have been postponed due to COVID-19 were recorded in the Departments of General-, Visceral-, Thoracic- and Vascular Surgery at the University Hospitals of Leipzig and Greifswald. Data was analysed descriptively concerning patient outcomes as well as emergency admissions and surgeries. Results: In the Leipzig and Greifswald University Hospitals 89 and 92 elective surgeries were postponed, respectively. No patient needed an extension of surgical procedure when eventually operated. One patient with extensive obesity died early during the suspension period due to cardiac complications. Four patients needed emergency admission to hospital one of whom required urgent surgery. In neither of the two surgical departments did a patient acquire a nosocomial infection with COVID-19. Discussion: While medical consequences of COVID-19 seem multidimensional and severe, our data indicate that the short-term postponement of elective surgery did not cause an unproportional increase of morbidity and mortality. Although the restrictions may have been fear-driven, given no confirmed cases and thus no concrete risk of infection, the early and well-coordinated action may have provided protection from uncontrolled interruption of medical services by loss of medical workforce or capacity. Conclusion: Well-organized and early suspension of elective surgery had no disproportionate impact on patient outcomes while averting nosocomial transmission of COVID-19.