PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to
determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free
surgical pathways were associated with lower postoperative pulmonary complication rates compared with
hospitals with no defined pathway.
PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective
surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included
patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined
as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and
inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with
COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute
respiratory distress syndrome, unexpected ventilation).
RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free
surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with
fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major
surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways
(2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses
for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and
patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also
lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76).
CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to
provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks |
