St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

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Summary

Introduction

This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines.

Method

A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-operative (n = 191) management during the UK COVID-19 pandemic peak (April–May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group).

Results

Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (p = 0.236).

Conclusion

We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.

Keywords

Coronavirus
Surgery
Plastic
Trauma
Burns
Injuries
General surgery

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The St Andrew's Collaborative Authors: Fateh Ahmad, Miles E Banwell, David E Barnes, Naguib El-Muttardi, Matthew Griffiths, Amer Hussain, Fortune C Iwuagwu, Loshan Kangesu, Waseem Khan, Niall Martin, Nabil Mopuri, Mary Morgan, Paul Morris, Patricia Rorison, Odhran Shelley, Adam Sierakowski, Makarand Tare, Kallirroi Tzafetta, Claire J Zweifel, Aswin Appukuttan, Tasneem Balgaumwala, Oliver Counter, Swapnil Deelip Dhake, Oscar F Fernandez-Diaz, Esther Gathura, Nicola Harris, Romulus Constantin Ion Jica, Devvrat Katechia, Scott Lavender, David G Martin, Alex Mertic, Adela Miranda, Jo Myers, Fady Nasrallah, Nicholas Pantelides, Sheila Prior, Sreekanth Raveendran, Tracey Sell, Reetu Sinha, Ben T Smeeton, Alex C D Smith, Stratos Sofos, Ben Strong, Jasmine Y M Tang, Amitabh Thacoor, Anne Tucker, Michele Turkentine, Mark Cornforth, Sally Cowdery, Alessandro Marasca, Helen Palmer, Carole Watts, Jan Watts, Rachel Wiltshire, Quillan Young Sing, Diana E Zberea, Nigel T Mabvuure

Acknowledgements: Karen Cook, John Cooil, Stewart Cooper, Sue Dines, Dylan Featherstone, Natalie Knowles, Charlotte Mcallister, Francesca Turner, Michael Wiseman

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