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

Publication ,  Journal Article
Glasbey, JC; Nepogodiev, D; Simoes, JFF; Omar, O; Li, E; Venn, ML; Pgdme; Abou Chaar, MK; Capizzi, V; Chaudhry, D; Desai, A; Edwards, JG ...
Published in: J Clin Oncol
January 1, 2021

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.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 1, 2021

Volume

39

Issue

1

Start / End Page

66 / 78

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Male
  • Logistic Models
  • International Cooperation
  • Humans
 

Citation

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Glasbey, J. C., Nepogodiev, D., Simoes, J. F. F., Omar, O., Li, E., Venn, M. L., … COVIDSurg Collaborative. (2021). Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. J Clin Oncol, 39(1), 66–78. https://doi.org/10.1200/JCO.20.01933
Glasbey, James C., Dmitri Nepogodiev, Joana F. F. Simoes, Omar Omar, Elizabeth Li, Mary L. Venn, Pgdme, et al. “Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.J Clin Oncol 39, no. 1 (January 1, 2021): 66–78. https://doi.org/10.1200/JCO.20.01933.
Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML, et al. Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. J Clin Oncol. 2021 Jan 1;39(1):66–78.
Glasbey, James C., et al. “Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.J Clin Oncol, vol. 39, no. 1, Jan. 2021, pp. 66–78. Pubmed, doi:10.1200/JCO.20.01933.
Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML, Pgdme, Abou Chaar MK, Capizzi V, Chaudhry D, Desai A, Edwards JG, Evans JP, Fiore M, Videria JF, Ford SJ, Ganly I, Griffiths EA, Gujjuri RR, Kolias AG, Kaafarani HMA, Minaya-Bravo A, McKay SC, Mohan HM, Roberts KJ, San Miguel-Méndez C, Pockney P, Shaw R, Smart NJ, Stewart GD, Sundar Mrcog S, Vidya R, Bhangu AA, 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. 2021 Jan 1;39(1):66–78.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 1, 2021

Volume

39

Issue

1

Start / End Page

66 / 78

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Male
  • Logistic Models
  • International Cooperation
  • Humans