The Coronavirus (COVID-19) pandemic led to widespread cancellation of elective surgery. However, the exact numbers of cancelled operations and the impact on patients is not known, because in England there is no coordinated national reporting system for surgery and related complications. There is now a clear priority to clear the surgical backlog. However, the continuing impact of COVID-19 on surgery is unclear. Systematic reporting of national data for surgical care is required to inform evidence-based public policy.
Aims
To investigate the impact of COVID-19 on outcomes after surgery; to monitor national surgical activity during the pandemic recovery and future peaks; and to estimate resource requirements for continuing elective surgery.
Methods
National observational study using routinely collected data from the NHS and Office for National Statistics. The cohort includes patients undergoing surgery in England from January 2020 onwards, with a historical comparison from January 2015 to December 2019. Patterns of operations during the pandemic are described, using statistics to identify links between COVID-19 and outcomes after surgery. We report the impact of the pandemic on surgery during the recovery from the pandemic.
Impact
We will generate data to inform healthcare policy by establishing a sustainable platform for reporting national surgical outcomes.
Figure: Age adjusted risk incidence of COVID-19 per 100,000 surgical patients (top) and risk of death (bottom).
Surgical site infection (SSI) affects 1 in 20 surgical patients and is an important cause of avoidable postoperative morbidity. Widespread use of antimicrobial drugs to prevent SSI is standard practice worldwide. However, evidence supporting antimicrobial prophylaxis is relatively weak, and was generated before the introduction of modern surgical and anaesthetic techniques, which reduce rates of SSI. Antimicrobials may also cause harm, with 1 in 50 surgical patients suffering complications directly attributable to antimicrobial drugs, including acute kidney injury, hearing loss and anaphylaxis. 1 in 7 patients carry a label of antimicrobial allergy, which results in the use of alternative antimicrobials that are less effective and more toxic, potentially leading to more side effects. At a societal level, the widespread use of antimicrobial drugs is the principal cause of antimicrobial resistance, which represents a serious threat to global healthcare.
We hypothesise that current practice for surgical antimicrobial prophylaxis may not be based on robust evidence of benefit versus risk.
Our research will determine whether there are 1) associations between the number of doses of antimicrobial drugs and incidence of SSI, mortality and hospital re-admission within 30 days after surgery; and 2) associations between these outcomes and the presence of antimicrobial allergy labels.Figure: Total number of doses of antimicrobial drug used for surgical prophylaxis.