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Safety of major reconstructive surgery during the peak of the COVID-19 pandemic in the United Kingdom and Ireland - multicentre national cohort study.

Authors
  • Patel, N G1
  • Reissis, D2
  • Mair, M3
  • Hart, A4
  • Ragbir, M5
  • Giele, H6
  • Mosahebi, A7
  • Ramakrishnan, V8
  • 1 Consultant Plastic and Reconstructive Surgeon, University Hospitals of Leicester, UK; University of Manitoba, Winnipeg, Canada; Department of Plastic and Reconstructive Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK. Electronic address: [email protected] , (Canada)
  • 2 Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK. Electronic address: [email protected]
  • 3 Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK.
  • 4 Canniesburn Plastic Surgery Unit, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK. Electronic address: [email protected]
  • 5 Department of Plastic and Reconstructive Surgery, Newcastle Upon Tyne Hospitals NHS Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK. Electronic address: [email protected]
  • 6 Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU UK. Electronic address: [email protected]
  • 7 Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK. Electronic address: [email protected]
  • 8 Anglia Ruskin University, Chelmsford UK; St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET UK. Electronic address: [email protected]
Type
Published Article
Journal
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
Publication Date
Jun 01, 2021
Volume
74
Issue
6
Pages
1161–1172
Identifiers
DOI: 10.1016/j.bjps.2020.12.032
PMID: 33402316
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The safety of surgery during and after the coronavirus disease-2019 (COVID-19) pandemic is paramount. Early reports of excessive perioperative mortality in COVID-positive patients promoted the widespread avoidance of operations. However, cancelling or delaying operations for cancer, trauma, or functional restitution has resulted in increased morbidity and mortality. A national multicentre cohort study of all major reconstructive operations carried out over a 12-week period of the 'COVID-19 surge' in the United Kingdom and Ireland was performed. Primary outcome was 30-day mortality and secondary outcome measures were major complications (Clavien-Dindo grade ≥3) and COVID-19 status of patients and healthcare professionals before and after surgery. A total of 418 patients underwent major reconstructive surgery with a mean operating time of 7.5 hours and 12 days' inpatient stay. Cancer (59.8%) and trauma (29.4%) were the most common indications. COVID-19 infection was present in 4.5% of patients. The 30-day post-operative mortality was 0.2%, reflecting the death of one patient who was COVID-negative. Overall complication rate was 20.8%. COVID status did not correlate with major or minor complications. Eight healthcare professionals developed post-operative COVID-19 infection, seven of which occurred within the first three weeks. Major reconstructive operations performed during the COVID-19 crisis have been mostly urgent cases involving all surgical specialties. This cohort is a surrogate for all major operations across all surgical specialties. Patient safety and surgical outcomes have been the same as in the pre-COVID era. With adequate precautions, major reconstructive surgery is safe for patients and staff. This study helps counsel patients of COVID-19 risks in the perioperative period. Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.

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