DAY CASE SURGERY
Using day surgery to recover elective surgery
Operating theatre teams will have a ‘marathon’ ahead as they battle to reduce waiting lists for elective surgery. The British Association for Day Surgery’s annual virtual conference highlighted the need to tackle national variation in day case surgery, as part of the road to recovery.
At the British Association for Day Surgery annual conference on ‘Using day surgery to recover elective surgery in the era of COVID-19’, held in March this year, the pressures facing theatre teams in the wake of the pandemic were high on the agenda. Professor Tim Cook, consultant in anaesthesia and intensive medicine, Royal United Hospital NHS Trust, Bath, discussed the current issues facing elective surgery and the scale of the challenge ahead. He showed evidence of the huge backlog of patients awaiting elective surgery and stressed there is a “pressing practical and moral imperative to address the waiting lists”.
He opened the discussion by highlighting the latest research which shows that the timing of surgery for patients who have had COVID has a significant impact on outcomes.1
Led by experts at the University of Birmingham, more than 25,000 surgeons worked together as part of the COVIDSurg Collaborative to collect data from 140,727 patients in 1,674 hospitals across 116 countries. The study found that patients are more than two-and-a-half times more likely to die after their operations, if the procedure takes places in the six weeks following a positive diagnosis for SARS-CoV-2. Publishing their findings in Anaesthesia,1 the researchers discovered that patients operated 0-6 weeks after SARS-CoV-2 infection diagnosis were at increased risk of postoperative death, as were patients with
ongoing symptoms at the time of surgery. Following a delay of seven weeks or more, patients with ongoing COVID-19 symptoms (6.0%) had higher mortality than patients whose symptoms had resolved (2.4%) or who had been asymptomatic (1.3%). Prof. Cook pointed out that it is important to remember that 80% of the population hasn’t had COVID-19 and the percentage of the surgical population who are post- COVID will be very small. However, shared decision-making regarding the timing
Currently, there aren’t any additional operating theatres; there aren’t any additional staff; and there isn’t any additional money. It won’t be a sprint to the finish; we should be
preparing for a marathon. Professor Tim Cook
AUGUST 2021
of elective surgery after COVID-19 must consider: l Severity of the initial infection l Ongoing symptoms of COVID-19 l Comorbid and functional status, both before and after COVID-19
l Clinical priority and disease progression l Complexity of surgery
Planned surgery should not be considered during the period that the patient is infectious. This is 10 days after mild/ moderate disease or 15-20 days after severe disease. Specialist advice will be required for the severely immunosuppressed (including post-dexamethasone or tociluzimab). It should also be noted that surgery should be avoided if the individual is symptomatic as there is an increased risk to the patient. However, if emergency surgery is vital, full- transmission-based precautions should be undertaken.
There should be no elective surgery within seven weeks of COVID-19 diagnosis,
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