Surgery Open Science (Oct 2022)

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

  • T Minto, MBChB,
  • T Abdelrahman, MD,
  • L Jones, MBA,
  • J Wheat, FRCS,
  • T Key, MBChB,
  • N Shivakumar, MBChB,
  • J Ansell, MD,
  • O Seddon, MBBCh,
  • A Cronin, FRCS,
  • A Tomkinson, FRCS,
  • A Theron, FRCA,
  • RW Trickett, MD,
  • N Sagua,
  • S Sultana,
  • A Clark,
  • E McKay,
  • A Johnson,
  • Karishma Behera,
  • J Towler,
  • H Kynaston, MD,
  • A Mohamed,
  • G Blackshaw,
  • R Thomas,
  • S Jones,
  • M Shinkwin,
  • H Perry,
  • D Edgbeare,
  • S Chopra,
  • L DaSilva,
  • I Williams,
  • U Contractor,
  • S Bell,
  • S Zaher,
  • M Stechman,
  • S Berry,
  • H Clark,
  • E Bois,
  • C Von Oppell,
  • L Ackerman,
  • E Ablorsu,
  • J Horwood,
  • D Mehta,
  • J Featherstone,
  • E Folaranmi,
  • M Bray,
  • K Siddall,
  • E King,
  • M Phillips,
  • J Morgan,
  • I Chopra,
  • D Evans,
  • K Whitehouse,
  • P Leach,
  • C Thomas,
  • E Davies,
  • M Dyer,
  • A Fox,
  • E Ireland,
  • E Meehan,
  • A Mukit,
  • K Newell,
  • D Parry,
  • B Popham,
  • C Chapman,
  • H Botros

Journal volume & issue
Vol. 10
pp. 168 – 173


Read online

Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P 70, male sex, American Society of Anesthesiologists grade >2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.