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Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey.

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Title: Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey.
Authors: Beatty, JW
Clarke, JM
Sounderajah, V
Acharya, A
Rabinowicz, S
Martin, G
Warren, LR
Yalamanchili, S
Scott, AJ
Burgnon, E
Purkayastha, S
Markar, S
Kinross, JM
PANSURG-PREDICT Collaborative
Item Type: Journal Article
Abstract: OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3 6%, compared to 15 5% for those with COVID-19. However, only 14 1% received a COVID-19 test on admission in March, increasing to 76 5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4 29), and COVID-19 infection (aOR 5 12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4 34; April aOR 4 25; May aOR 3 97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63 6% with a concomitant 27 3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
Issue Date: Dec-2021
Date of Acceptance: 1-Aug-2021
URI: http://hdl.handle.net/10044/1/91327
DOI: 10.1097/SLA.0000000000005152
ISSN: 0003-4932
Publisher: Lippincott, Williams & Wilkins
Start Page: 904
End Page: 912
Journal / Book Title: Annals of Surgery
Volume: 274
Issue: 6
Copyright Statement: © 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Sponsor/Funder: Digital Surgery Limited
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: ICL001
RDB04 79560
RD207
RDB04
Keywords: PANSURG-PREDICT Collaborative
Surgery
11 Medical and Health Sciences
Publication Status: Published
Conference Place: United States
Online Publication Date: 2021-12
Appears in Collections:Department of Surgery and Cancer
Mathematics
Applied Mathematics and Mathematical Physics
Faculty of Medicine
Institute of Global Health Innovation
Imperial College London COVID-19
Faculty of Natural Sciences



This item is licensed under a Creative Commons License Creative Commons