Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

被引：169

作者：

Glasbey, James C. ^{[1
]}

Nepogodiev, Dmitri ^{[1
]}

Simoes, Joana F. F. ^{[1
]}

Omar, Omar ^{[1
]}

Li, Elizabeth ^{[2
]}

Venn, Mary L. ^{[3
]}

Abou Chaar, Mohammad K. ^{[4
]}

Capizzi, Vita ^{[5
]}

Chaudhry, Daoud ^{[2
]}

Desai, Anant ^{[6
]}

Edwards, Jonathan G. ^{[7
]}

Evans, Jonathan P. ^{[8
]}

Fiore, Marco ^{[5
]}

Videria, Jose Flavio ^{[9
]}

Ford, Samuel J. ^{[6
]}

Ganly, Ian ^{[10
]}

Griffiths, Ewen A. ^{[11
]}

Gujjuri, Rohan R. ^{[2
]}

Kolias, Angelos G. ^{[12
]}

Kaafarani, Haytham M. A. ^{[13
]}

Minaya-Bravo, Ana ^{[14
]}

McKay, Siobhan C. ^{[15
]}

Mohan, Helen M. ^{[16
]}

Roberts, Keith J. ^{[15
]}

San Miguel-Mendez, Carlos ^{[14
]}

Pockney, Peter ^{[17
,34
]}

Shaw, Richard ^{[18
]}

Smart, Neil J. ^{[19
]}

Stewart, Grant D. ^{[20
]}

Sundar, Sudha ^{[21
]}

Vidya, Raghavan ^{[22
]}

Bhangu, Aneel A. ^{[2
]}

Siaw-Acheampong, Kwabena

Benson, Ruth A.

Bywater, Edward

Dawson, Brett E.

Heritage, Emily

Jones, Conor S.

Kamarajah, Sivesh K.

Khatri, Chetan

Khaw, Rachel A.

Keatley, James M.

Knight, Andrew

Lawday, Samuel

Mann, Harvinder S.

Marson, Ella J.

McLean, Kenneth A.

Mills, Emily C.

Pellino, Gianluca

Picciochi, Maria

机构：

[1] Univ Birmingham, NIHR Global Hlth Res Unit Global Surg, Birmingham, W Midlands, England

[2] Univ Birmingham, Birmingham, W Midlands, England

[3] Queen Mary Univ London, London, England

[4] King Hussein Canc Fdn, King Hussein Canc Ctr, Amman, Jordan

[5] Fdn IRCCS Ist Nazl Tumori, Milan, Italy

[6] Queen Elizabeth Hosp Birmingham, Midlands Abdominal & Retroperitoneal Sarcoma Unit, Birmingham, W Midlands, England

[7] Sheffield Teaching Hosp NHS Fdn Trust, Sheffield, S Yorkshire, England

[8] Nottingham Univ Hosp NHS Trust, Nottingham, England

[9] Francisco Gentil Portuguese Inst Oncol Porto, Inst Portugues Oncol Porto Francisco Gentil EPE, Porto, Portugal

[10] Mem Sloan Kettering Canc Ctr, New York, NY USA

[11] Queen Elizabeth Hosp Birmingham, Birmingham, W Midlands, England

[12] Univ Cambridge, Addenbrookes Hosp, Cambridge, England

[13] Harvard Med Sch, Ctr Outcomes & Patient Safety Surg, Boston, MA 02115 USA

[14] Henares Univ Hosp, Hosp Univ Henares, Madrid, Spain

[15] Queen Elizabeth Hosp Birmingham, Liver Unit, Birmingham, W Midlands, England

[16] St James Hosp, Dublin, Ireland

[17] Univ Newcastle, Newcastle, NSW, Australia

[18] Univ Liverpool, Liverpool Head & Neck Ctr, Liverpool, Merseyside, England

[19] Royal Devon & Exeter NHS Fdn Trust, Exeter, Devon, England

[20] Univ Cambridge, Cambridge, England

[21] City Hosp, Pan Birmingham Gynaecol Canc Ctr, Birmingham, W Midlands, England

[22] Royal Wolverhampton Hosp NHS Trust, Wolverhampton, W Midlands, England

[23] Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina

[24] Sanatorio 9 Julio Sa, San Miguel De Tucuman, Tucuman, Argentina

[25] Sanatorio Allende, Cordoba, Argentina

[26] Nairi Med Ctr, Yerevan, Armenia

[27] Calvary Mater Newcastle, Waratah, Australia

[28] Canberra Hosp, Canberra, ACT, Australia

[29] Coffs Harbour Hlth Campus, Coffs Harbour, Australia

[30] Concord Repatriat Gen Hosp, Concord West, Australia

[31] Fiona Stanley Hosp, Murdoch, WA, Australia

[32] Flinders Med Ctr, Bedford Pk, SA, Australia

[33] Gold Coast Univ Hosp, Southport, Qld, Australia

[34] John Hunter Hosp, New Lambton Hts, Australia

[35] Lifehouse, Camperdown, NSW, Australia

[36] Lismore Base Hosp, Lismore, NSW, Australia

[37] Logan Hosp, Meadowbrook, Qld, Australia

[38] Princess Alexandra Hosp, Woolloongabba, Qld, Australia

[39] Queen Elizabeth II Jubilee Hosp, Coopers Plains, Australia

[40] Royal Adelaide Hosp, Adelaide, SA, Australia

[41] Royal Brisbane & Womens Hosp, Herston, Qld, Australia

[42] St Vincents Hosp, Fitzroy, Vic, Australia

[43] Kardinal Schwarzenberg Klinikum, Schwarzach, Austria

[44] Landeskrankenhaus Feldkirch, Feldkirch, Austria

[45] Med Univ Innsbruck, Innsbruck, Austria

[46] Paracelsus Med Univ Salzburg, Salzburg, Austria

[47] Leyla Med Ctr, Baku, Azerbaijan

[48] Queen Elizabeth Hosp, Bridgetown, Barbados

[49] Az Delta, Roeselare, Belgium

[50] Uz Leuven, Leuven, Belgium

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2021年 / 39卷 / 01期

基金：

英国医学研究理事会;

关键词：

OUTCOMES;

D O I：

10.1200/JCO.20.01933

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION 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.

引用

页码：66 / +

页数：22

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