Surgical Procedures During COVID-19: Prospective Cohort Analysis from Nottingham

Overview

This report details the formation and outcomes of a multidisciplinary COVID Cancer Surgery group at Nottingham University Hospitals NHS Trust during the COVID-19 peak. It highlights the prioritization framework for urgent and cancer surgeries, resource allocation, and clinical outcomes amid pandemic constraints.

Background

The COVID-19 pandemic led to the deferral of over 28 million surgeries worldwide, with early reports indicating high postoperative mortality in SARS-CoV-2 infected patients. In the UK, non-urgent surgeries were suspended for three months starting April 2020 to preserve NHS capacity. Urgent and cancer surgeries continued but faced delays depending on local COVID-19 burden. Nottingham University Hospitals NHS Trust established a multidisciplinary group to oversee prioritization and resource management for these critical cases during the pandemic peak.

Data Highlights

The group coordinated surgery across two NHS hospital sites and two Independent Sector hospitals, managing 42 operating theatres and 1300 beds. Daily prioritization of the five most urgent cases per specialty was conducted, balancing theatre availability, anaesthetic staffing, and critical care capacity. Preoperative COVID-19 screening initially relied on symptom questionnaires and temperature checks, with PCR testing introduced later. Separate 'clean' sites were established in Independent Sector hospitals to minimize nosocomial infection risk.

Key Findings

• A multidisciplinary COVID Cancer Surgery group was rapidly formed to prioritize urgent and cancer surgeries during the pandemic.
• Prioritization decisions incorporated clinical urgency, potential for cure, surgical complexity, patient factors, and local COVID-19 prevalence.
• Resource constraints included anaesthetic staffing reallocation, reduced critical care capacity, and theatre staff redeployment.
• Separate clean surgical pathways and sites were established to reduce COVID-19 transmission risk.
• Daily case submissions and prioritization allowed flexible scheduling aligned with available resources.
• Ethical oversight with lay representation was integrated into decision-making processes.

Clinical Implications

Clinicians should adopt a structured, multidisciplinary approach to prioritize urgent and cancer surgeries during pandemic conditions, balancing patient benefit against resource limitations and infection risks. Establishing clean surgical pathways and flexible scheduling can maintain essential surgical services safely. Ethical considerations and transparent communication with patients about COVID-19 risks are critical.

Conclusion

The Nottingham experience demonstrates that coordinated multidisciplinary governance and adaptive resource management enable the continuation of urgent and cancer surgeries with controlled COVID-19 risk during pandemic peaks. This framework may inform surgical service delivery in ongoing or future healthcare crises.

References

1. COVIDSurg Collaborative 2020 -- Global surgery cancellations due to COVID-19
2. Initial reports on postoperative mortality in COVID-19 patients
3. National and International perioperative COVID-19 guidance
4. UK NHS suspension of non-urgent surgeries April 2020
5. Nottingham University Hospitals NHS Trust COVID Cancer Surgery group formation
6. Infection control measures and clean surgical sites