‘COVID-19 free’ hospital areas could save lives after surgery – global study

Governments around the world have been urged to as a matter of urgency invest in setting up ‘COVID-19 free’ hospital areas to protect surgical patients from the risk of death from cancer and lung infections associated with coronavirus.

Addressing the governments in a global study led by researchers at the University of Birmingham and the COVIDSurg Collaborative, comprising experts from over 130 countries, which was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant, experts warned that as the second wave of the Covid-19 pandemic approaches, delay in operations for cancer and other time-dependent surgeries could progress to be untreatable and lead to deaths.

The findings of the report published in the Journal of Clinical Oncology 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.

The experts noted that due to fear that patients may contract COVID-19 in hospitals, millions of surgeries around the world were cancelled during the first wave of the pandemic, which resulted to many deaths.

The rsearchers examined data from 9171 patients in 55 countries, across five different continents from the start of the pandemic up the middle of April 2020 and discovered 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.

While it is estimated that around 2.2 million operations take place in Nigeria each year, of which around 230,000 are for removal of a cancer, this research 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.

Researchers working together around the world found that patients who had their operation and hospital care in ‘COVID-19 free’ areas had better outcomes with improved safety of surgery by having a strict policy that no patients treated for COVID-19 were mixed with those undergoing surgery.

The Collaborative lead, Dr. Aneel Bhangu, from the NIHR Global Health Research Unit on Global Surgery, at the University of Birmingham, stressed that 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, adding that these can be tailored to the resources available locally, ensuring that patients treated for COVID-19 are not mixed with patients needing surgery.

“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,” he said.

Also, the national study lead at College of Medicine, University of Lagos, Prof. Adesoji Ademuyiwa said: “The implication of this study to us in Nigeria and other low- and middle-income countries is that, we must begin to look at ways to have Covid-19 free dedicated theatres akin to the model used by the Lagos University Teaching Hospital during the pandemic which allowed surgeries to continue while Covid-19 positive patients were operated in other dedicated theatre. This global study has now shown that several lives can be saved with such arrangement and this should be promoted across the different strata of the health system in our country”

While the study lead at the University of Birmingham, James Glasbey pointed that major reorganisation of hospital services to provide COVID-19 free areas for elective surgery must be justified by evidence like this, as it redirects time and resources away from other services.

“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. We recommend that COVID-19 free areas are set-up in all countries currently affected by the pandemic, including those likely to suffer from future waves.

“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.”