Interview by Rohan Gujjuri.
The coronavirus disease 2019 (COVID-19) has affected millions of people, having spread to most countries since the WHO declared the situation a pandemic. [1] The resilience of healthcare systems has been tested, especially in the management of more vulnerable groups of patients, such as those undergoing surgery. In this interview, Gianluca Pellino, a colorectal surgeon from the Vall d'Hebron University Hospital in Barcelona (Spain) provides a brief summary of the efforts and findings on behalf of the CovidSurg collaborative. Gianluca is on the communications committee for the European Society of Coloproctology (ESCP) and is acting in a similar capacity on the CovidSurg collaborative.
The CovidSurg collaborative has been developed by the same team that has started the GlobalSurg initiative as a response to the emerging effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on surgical services. It has been endorsed by several societies including the ESCP. CovidSurg represents a platform to facilitate collaboration on a global scale with the aim of producing evidence on COVID-19 management in a rapid but scientifically sound manner. The initiative of CovidSurg are multiple and synchronous; the group has been working on several modelling studies to inform hospital management and team planning.
A manuscript published in the British Journal of Surgery (BJS), described a prediction of how many elective surgeries were being cancelled during the COVID outbreak in different countries. [2] Researched collected the detailed information from surgeons worldwide and modelled data to estimate totals for cancelled surgeries across 190 countries. They anticipated that, in the United Kingdom alone, by assuming that most elective surgeries are cancelled for 12 weeks, there would be a cancellation of 516,000 surgeries. This would include 36,000 cancelled procedures. This is resulting in a backlog that would need to be cleared in the restoration phase. They also estimated that, if after the disruption ends, the NHS increases number of surgeries performed each week by 20% compared to the pre-pandemic level, it would take 11 months to clear the backlog. Of note, each additional week will lead to the cancellation of an additional 43,000 surgeries significantly the time period required to clear the backlog. Clearing this has been estimated to cost the UK, £2 billion.
CovidSurg made national data to be available publicly in order to help surgeons and healthcare authorities to action promptly. The collaborative also produced, in a timely manner, a global guidance to be used when performing surgery during the pandemic. [3] This consisted of an up-to-date review of articles describing the management of surgical patients during the pandemic with informative interviews from surgeons and anaesthetists with direct experience of working in the pandemic. They were able to identify the key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic. The resulting contribution has been published in the BJS and served as a practical guidance based on the experiences of those that were going through the pandemic at a time when evidence was scarce and of poor quality.
Alongside the modelling study, CovidSurg has started global cohort studies capturing data on those operated on during the pandemic. The CovidSurg cohort study assesses outcomes of surgery in patients who are diagnosed with COVID-19. This includes patients undergoing any type of surgery, who are diagnosed with COVID-19 infection at the time of surgery or within 30 days. CovidSurg Cancer study will look at all cancer patients with a decision for surgery. This includes both operated and non-operated patients, regardless being COVID positive or negative.
An analysis of the postoperative outcomes of the first 1128 patients from 235 hospitals included from 24 countries has been published in the Lancet. [4] The main goal was to assess 30-day outcomes for patients undergoing surgery who acquired perioperative SARS-CoV-2 infection. SARS- CoV-2 infection was defined as infection diagnosed within 7 days before or 30 days following surgery. Overall 30-day mortality was 24% with nearly half of all patients having pulmonary complications after surgery; 38% of these died within 30-days after surgery. Male sex, Age > 70 years, ASA grade 3-5, Malignant disease, emergency and major surgery were identified as significant risk factors for surgery with all the patient subgroups have worse outcomes than before the pandemic. The findings suggest that surgery should be postponed whenever possible, especially in patients with risk factors. Moreover, this data should be discussed with patients ahead of surgery.
Further analyses are planned so new centres are very welcome. At the time of this interview, 733 centres from 73 countries have contributed to CovidSurg with data on more than 24,000 thousand uploaded on the database. The group aims to reach and support all healthcare stakeholders including patients. A booklet for patient information has been recently developed to provide insight on the most common questions and uncertainties that patients are facing during the pandemic. The original version is in English with translations planned into other languages. This can be found on the website.
The true strength of CovidSurg is the powerful and truly global reach that its initiatives have been achieving so far. The group is hosting several webinars and is producing several press releases. It has been featured on the ESCP website and BJS Cutting Edge blog. All the mentioned and upcoming initiatives have been endorsed by the ESCP. Everyone is encouraged to join and contribute to the growth of CovidSurg.
Many thanks to ESCP and its members for their contribution to this collaborative effort in learning about the COVID-19 pandemic in surgery and cancer.
Please find more information about the CovidSurg collaborative on our website, Twitter, Instagram and Facebook.
- WHO. WHO announces COVID-19 outbreak a pandemic. March 12, 2020. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic (accessed April 19, 2020).
- CovidSurg Collaborative, Nepogodiev D, Bhangu A. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans [published online ahead of print, 2020 May 12]. Br J Surg. 2020;10.1002/bjs.11746. doi:10.1002/bjs.11746
- COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; published online April 15. DOI:10.1002/bjs.11646.
- COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study [published online ahead of print, 2020 May 29]. Lancet. 2020;S0140-6736(20)31182-X. doi:10.1016/S0140-6736(20)31182-X
