St Andrew's COVID-19 Surgery Safety (StACS) Study: Elective Plastic Surgery, Trauma & Burns

BH, Miranda; WRM, Hughes; R, Pinto-Lopes; BS, Mathur; VV, Ramakrishnan; MK, Sood

INTRODUCTION: : This study evaluates COVID-related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-safety guidelines. METHOD: : A prospective cohort study was undertaken in all patients who underwent surgical (n=1429) or non-operative (n=191) management during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-related death. A representative sample of elective/trauma/burns patients (surgery group, n=729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n=100) or waiting list (control group, n=250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). RESULTS: : Complex general (9.2%,136/1483) or regional (5.0%,74/1483) anaesthesia cases represented 14.2%(210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-related deaths. Neither the 3 sub-specialty plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1%(1/14) (non-operative), 5.9%(2/34) (burns) and 3.0%(3/99) (trauma); there were however no significant differences between these groups, the elective (0%,0/54) and control (0%,0/24) groups (p=0.236). CONCLUSION: : We demonstrate that even heterogeneous sub-specialty patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.