Elective surgery patients to be screened for COVID-19

Prof Paul Myles in theatre

by Tania Ewing

A Monash University researcher warns, in an editorial in The Lancet, that countries aiming to reintroduce elective surgery should be prepared to balance the need for surgery over the risk of a compromised patient developing COVID-19 and dying.

Professor Paul Myles, from the Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, has written the editorial to accompany a research paper from the University of Birmingham, which looked at more than 1100 patients across 24 countries who had surgery from the 1 January to 31 March this year. More that two thirds of these patients were diagnosed with coronavirus post-operatively. One in four of these patients were dead within 30 days of the surgery.

The study found that 26% of these patients had elective surgery despite there being evidence that the coronavirus was escalating globally.

Professor Myles, who wrote the editorial with Professor Salome Maswime, from the University of Cape Town in South Africa, warns that the message from the study is that countries should not consider returning to elective surgery “unless the hospital system is fully equipped with personal protective equipment, ICU beds and staff trained in dealing with COVID patients,” he said.

Australia is currently operating at 25% elective surgery being conducted in private and public hospitals with 50% by this Monday, 75% by 30 June and 100% by 31 July, according to Professor Myles who is also the head of a recently formed National Elective Surgery Taskforce in collaboration with the Australian National University. This taskforce will screen more than 3000 elective surgery patients over the next six weeks in 14 hospitals nationally for both evidence of the virus and antibodies, indicating previous infection.

More than eight million people will be on UK surgery waiting lists by the northern autumn because of treatment delays caused by the coronavirus outbreak, and a report in Australia from a survey of more than 1000 GPs warned that there may be a surge in patients needing surgery because of a reduction in screening for disease such as melanoma and a rise in hospitalisation for patients with chronic illness who have been unable or unwilling to seek their usual ongoing medical care.

“Hospitals – globally – really shouldn’t return to elective surgery until the COVID situation is under control in their region,” Professor Myles warned. “Places like Australia have the COVID infection largely under control, but in some part of the world where political leaders urging a 'return to normal' before they have COVID under control – opening for elective surgery could lead to a major increase in mortality.”

As quoted in the 13 June The Age article, Prof Myles said while Australia was in a vastly different position after avoiding an onslaught of critically-ill coronavirus patients, the rate of virus lingering in the community remained unknown.

"What this [taskforce study] is going to do is hopefully confirm the incidence of coronavirus in the community is incredibly low," he said.

See more:

• 13 June The Age www.theage.com.au/national/thousands-of-elective-surgery-patients-to-be-screened-for-covid-19-20200612-p55212.html
• An Australian Study of Coronavirus Infection (COVID-19) in Elective Surgery
• Myles PS, Maswime S. Mitigating the risks of surgery during the COVID-19 pandemic. Lancet. 2020 May 29. pii: S0140-6736(20)31256-3. doi: 10.1016/S0140-6736(20)31256-3.