‘COVID-19 free’ hospitals to end cancer surgery backlog

With more than two million* non-emergency surgeries being cancelled globally every week due to COVID-19, researchers say the findings will have a major impact on how healthcare systems are set up and should reassure ‘at risk’ cancer patients fearful of attending appointments. 

The study, published on the pre-print server medRxiv and awaiting peer-review, reports on the first 500 patients who had surgery at the University College Hospital at Westmoreland Street, London, during the coronavirus pandemic.

To facilitate cancer patients with an urgent clinical need of surgery, the North Central London and North East London Cancer Hub, coordinated by UCLH and supported by UCL, set up a surgery and cancer network involving 14** separate NHS trusts. This hub was part of an approach to manage cancer surgery involving the Cancer Alliances in London and NHS England.

Between March 5, 2020 and April 22, 2020, at University College Hospital at Westmoreland Street (part of UCLH), 500 operations were performed, primarily for the diagnosis or treatment of cancer.

Of those operations, 44% were performed with robotic or endoscopic assistance, and 61% were classified as major or complex surgery. The study’s primary outcome, the ‘30 day mortality rate’, reports that no patient died from COVID-19 at 30-days.

The study’s secondary outcome, the number of patients diagnosed with COVID-19 following surgery, was 10 (2%) patients. Of these 4 (≤1%) of patients had confirmed laboratory diagnosis, with 6 (≥1%) deemed likely to have had COVID-19. University College Hospital at Westmoreland Street is the first ‘COVID-19 free cold site’ to report its findings.

Lead author, Dr Veeru Kasivisvanathan, NIHR Academic Clinical Lecturer at UCL Division of Surgery and Interventional Science and Specialist Registrar at UCLH, said: “The study was carried out during the peak of the pandemic in the UK, which now has one of the world’s highest numbers of coronavirus cases and deaths.

“By working together with 14 other hospital trusts, as part of a coordinated effort to keep one surgical site free from COVID, we have shown it is safe to continue high volume urgent cancer surgeries. None of our first 500 patients, operated on during the pandemic, died from COVID-19.

“Our model gives other institutions around the world an example of how to reconfigure their services to offer safe surgery.”

The North Central and North East London cancer hub is one of three cancer hubs set up in London and has implemented a series of measures designed to minimise the transmission and spread of the virus.

Measures include setting up the Westmoreland Street site, along the independent sector capacity at Wellington Hospital and the Princess Grace Hospitals, in London, as dedicated ‘COVID-free’ surgery facilities. These hospitals divert walk-in or emergency admissions to alternative sites within the network to ensure that stricter infection control measures can be taken, such as restricting visitors or telephone screening patients, to ensure they are asymptomatic before coming in for their surgery.

Other measures included: increasing deep cleaning, requesting patients isolate before and after their surgery, swab testing patients suspected of having COVID-19, and wearing full PPE in theatre for every case.

In addition to the completed study, UCL/UCLH can now confirm more than 1000 patients have been operated on at the three ‘COVID-19 free cold sites’ coordinated by the North Central London and North East London Cancer Hub.

Professor John Kelly, Professor of Uro-Oncology at UCL Surgery & Interventional Science, and Consultant Surgeon at UCLH, said: “This study is important as we are finding that many patients don’t want to have their surgery anymore because they are worried about COVID-19.

“The results show that it is safe for them to continue with their surgery providing appropriate service reconfiguration takes place. Delaying surgery can lead to patients’ cancers progressing, which could result a worse quality of life. This set up allows the highest risk cancer patients, who would benefit most from surgery to be prioritised.” 

Supporting the ‘COVID-19-free cold site’ strategy, at the start of the pandemic The Francis Crick Institute, London, repurposed its laboratories into COVID-19 testing facilities, helping ensure healthcare workers and patients at UCLH could be tested for coronavirus rapidly. 

Professor Charles Swanton, Group Leader at the Crick and UCL, Consultant at UCLH and Cancer Research UK’s chief clinician, said: “Setting up COVID Protected cancer hubs will play a vital role in the NHS recovery plan to return to normal cancer activity. The Crick Institute/UCLH COVID-19 Consortium has provided a COVID testing facility for UCLH and London Hospitals with the specific goal of creating COVID-safe clinical environments.

“This is a wonderful example of a COVID protected cancer hub in practice at the peak of the London pandemic demonstrating that safe hospital environments can be generated through service reconfiguration and routine COVID testing to protect patients from post-operative complications. This remarkable achievement will provide the confidence patients and clinicians need to return to normal cancer activities as quickly as possible across the NHS.”

This research paper has been submitted to an academic journal and is awaiting peer-review.

Links

• Pre-print research paper on medRxiv
• Professor John Kelly’s academic profile
• Dr Veeru Kasivisvanathan’s academic profile
• Professor Charles Swanton’s academic profile
• UCL Surgery & Interventional Science
• UCL Cancer Institute
• UCLH
• The Francis Crick Institute

Image

• ‘Surgeons at UCLH wear full PPE to control a robot designed to remove a patient's prostate cancer’, credit Sky News

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Henry Killworth

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