Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study
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- James C. Glasbey
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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- Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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- Joana F.F. Simoes
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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- Omar Omar
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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- Elizabeth Li
- University of Birmingham, Birmingham, United Kingdom
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- Mary L. Venn
- Queen Mary University of London, London, United Kingdom
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- PGDME
- Queen Mary University of London, London, United Kingdom
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- Mohammad K. Abou Chaar
- King Hussein Cancer Foundation: King Hussein Cancer Center, Amman, Jordan
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- Vita Capizzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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- Daoud Chaudhry
- University of Birmingham, Birmingham, United Kingdom
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- Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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- Jonathan G. Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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- Jonathan P. Evans
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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- Marco Fiore
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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- Jose Flavio Videria
- Francisco Gentil Portuguese Institute for Oncology of Porto: Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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- Samuel J. Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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- Ian Ganly
- Memorial Sloan Kettering Cancer Center, New York, NY
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- Ewen A. Griffiths
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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- Rohan R. Gujjuri
- University of Birmingham, Birmingham, United Kingdom
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- Angelos G. Kolias
- Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
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- Haytham M.A. Kaafarani
- Harvard Medical School, Centre for Outcomes & Patient Safety in Surgery, Boston, MA
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- Ana Minaya-Bravo
- Henares University Hospital: Hospital Universitario del Henares, Madrid, Spain
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- Siobhan C. McKay
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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- Helen M. Mohan
- St. James Hospital, Dublin, Ireland
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- Keith J. Roberts
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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- Carlos San Miguel-Méndez
- Henares University Hospital: Hospital Universitario del Henares, Madrid, Spain
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- Peter Pockney
- University of Newcastle, NSW, Australia
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- Richard Shaw
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
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- Neil J. Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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- Grant D. Stewart
- University of Cambridge, Cambridge, United Kingdom
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- Sudha Sundar, MRCOG
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, United Kingdom
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- Raghavan Vidya
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
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- Aneel A. Bhangu
- University of Birmingham, Birmingham, United Kingdom
説明
<jats:sec><jats:title>PURPOSE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p>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.</jats:p></jats:sec>
収録刊行物
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- Journal of Clinical Oncology
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Journal of Clinical Oncology 39 (1), 66-78, 2021-01-01
American Society of Clinical Oncology (ASCO)
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詳細情報 詳細情報について
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- CRID
- 1360572092506132992
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- ISSN
- 15277755
- 0732183X
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- データソース種別
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- Crossref
- KAKEN