‘Covid-19 free’ hospital areas could save lives after surgery – a global study
- Wits University
A global study has found that setting up ‘Covid-19 free’ hospital areas for surgical patients could save lives during the second wave of the pandemic.
Researchers in the Faculty of Health Sciences at Wits working in University-affiliated hospitals contributed to the study that found that patients who had their operation and hospital care in ‘Covid-19 free’ areas had better outcomes.
‘Covid-19 free’ areas were set up both in smaller, independent hospitals and large hospitals with emergency departments. ‘Covid-19 free’ areas improved the safety of surgery by having a strict policy that no patients treated for Covid-19 were mixed with those undergoing surgery. Such protection areas reduced the risk of death from lung infections associated with coronavirus.
The global study by the COVIDSurg Collaborative, led by the University of Birmingham, comprises experts from over 130 countries, including South Africa. The Collaborative published findings in the Journal of Clinical Oncology on 6 October 2020.
“These study findings are applicable to the South African context in that cancer surgery can safely continue in the face of the Covid-19 pandemic, with protection of both patients and staff, by keeping Covid-19 patients and patients needing cancer surgery separated by having designated Covid-19 areas in the hospital,” says Dr Rachel Moore, Johannesburg Hub Lead of the National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery.
Moore is a specialist surgeon and Head of Acute Care Surgery at Chris Hani Baragwanath Academic Hospital and an Associate Lecturer in Surgery in the School of Clinical Medicine at Wits.
Mitigating possibly deadly delays to cancer surgery
Millions of patients around the world had their surgery delayed because of coronavirus. However, surgery for conditions such as cancer must continue despite the threat of a second wave. When operations for cancer and other time-dependent surgeries are delayed, these diseases can progress towards untreatable.
Cancer surgery is essential surgery and was thus (and continues to be) consistently prioritized at Wits-affiliated hospitals, even during the peak in Covid-19 numbers in Gauteng. As a second wave approaches, more patients face delays. This study has shown, for the first time, that hospitals around the world can continue safe surgery by setting up ‘Covid-19 free’ areas to minimise the risk from the coronavirus.
“As health providers restart elective cancer surgery, they must look to protect cancer surgery patients from harm by investing in dedicated 'Covid-19 free' hospital areas. These can be tailored to the resources available locally, ensuring that patients treated for Covid-19 are not mixed with patients needing surgery,” says Dr Aneel Bhangu, Collaborative lead at the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham.
"However, this represents a significant challenge to many hospitals around the world. Governments and hospital providers must help to fund this major international redesign of surgical services and provide protection for patients. 'Covid-19 free' areas could save many lives during future waves by allowing surgery to continue safely despite high rates of infection in the community.”
Therefore, the approach taken in South African hospitals was to continue with cancer surgeries but to keep Covid-19 patients and patients admitted for essential elective surgery separated in different areas of the hospital.
“The findings of this study confirm that this approach [‘Covid-19 free’ areas] was both justified and necessary for mitigating the risk from Covid-19 in patients undergoing cancer surgery. This response should be maintained as a pragmatic response to balancing the risk of delaying cancer surgery and the risk of Covid-19 infection,” says Moore.
About the study
Researchers examined data from 9171 patients in 55 countries, across 5 different continents from the start of the pandemic up the middle of April 2020.
It covered adult patients undergoing elective surgery with curative intent for a range of suspected cancers including bowel, gullet, stomach, head and neck, lung, liver, pancreas, bladder, prostate, kidney, womb, cervix, ovarian, breast, sarcoma and brain tumours.
Despite the finding that pulmonary complication (2.2% vs, 4.9%) and rates of death after surgery (0.7% vs 1.7%) were lower for patients who had their hospital treatment in ‘Covid-19 free’ areas, in this study, just 27% of patients had their care in these protected areas.
“Major reorganisation of hospital services to provide 'Covid-19 free' areas for elective surgery must be justified by evidence like this. We have proved that those efforts are essential in protecting patients undergoing surgery during the pandemic. Our data showed that 'Covid-19 free' hospital areas were beneficial when the rate of infection in the community was both low and high," says Dr James Glasbey, Study Lead at the University of Birmingham."However, overcoming the challenges of setting up such pathways, including separate hospitals to provide elective surgery, may lead to unintended consequences. Consequences for hospitals must be carefully monitored to achieve the best balance of healthcare for patients.”
Participating countries included: Argentina, Armenia, Australia, Austria, Azerbaijan, Barbados, Belgium, Brazil, Canada, Chile, Colombia, Croatia, Cyprus, Czech Republic, Denmark, Egypt, Ethiopia, Finland, France, Germany, Greece, Hong Kong SAR, China, Hungary, India, Ireland, Italy, Japan, Jordan, Libya, Madagascar, Malaysia, Mexico, Morocco, Netherlands, Nigeria, Oman, Pakistan, Peru, Poland, Portugal, Puerto Rico, Reunion, Romania, Russian Federation, San Marino, Saudi Arabia, Serbia, Singapore, Slovak Republic, South Africa, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States, Uruguay
The study was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant, which awarded £7 million to the University of Birmingham to establish the NIHR Global Health Research Unit on Global Surgery
This unit conducts multi-country randomised controlled trials testing interventions to reduce surgical site infection (SSI) across a range of low- and middle-income countries. The unit has established sustainable partnerships with the aim of leveraging global policy change at hospitals including at the Wits University-affiliated Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.