Global study finds ‘COVID-19 free’ hospital areas could save lives after surgery

Millions of surgeries around the world were cancelled during the first wave of the pandemic, for fear patients might contract COVID-19 in hospital.

As the second wave peak approaches, a new global study suggests hospitals should set up ‘COVID-19 free’ areas for surgical patients – and that doing so could reduce the risk of serious complications and death from lung infections associated with coronavirus.

Janet Martin, Associate Professor at Western University’s Schulich School of Medicine & Dentistry, is part of the CovidSurg Collaborative which includes researchers working together from around the world. The team found patients undergoing cancer surgery had better outcomes when their operation and hospital care took place in in ‘COVID-19 free’ areas.

COVID-19 free areas improved the safety of surgery by having a strict policy that patients with COVID-19 are not mixed with those undergoing surgery. The research looked at COVID-19 free areas both in smaller independent hospitals and large hospitals with emergency departments, demonstrating the feasibility of doing so in all settings.


Janet Martin, PharmD, Associate Professor at Schulich Medicine Dentistry, Western University.

“When we say ‘COVID-free areas’, we are talking about creating spaces that have no mixing with COVID patients throughout the entire surgical flow. That includes every stage from pre-admit, to surgery, intensive care and the ward where patients recover,” said Martin. “This research shows every hospital should aim to have intentional COVID-free areas for surgical patients.”

Researchers examined data from 9171 patients in 55 countries from the start of the pandemic to the middle of April 2020. They discovered pulmonary complications (2.2% vs 4.9%), perioperative COVID-19 (2.1% and 3.6%), and death after surgery (0.7% vs 1.7%) were lower for patients whose hospital treatment took place in ‘COVID-19 free’ areas. However, in this study, just 27 per cent of patients had their care in these protected areas.

More than 300 million surgeries take place worldwide each year. The study points out that this raises the possibility of preventing millions of serious pulmonary complications and deaths by setting up devoted COVID-19 free hospital areas to protect patients undergoing surgery. In Canada alone, implementing COVID-19 free surgical paths could prevent tens of thousands of surgical patients from complications and deaths.

Led by researchers at the University of Birmingham, the CovidSurg Collaborative comprises of experts from over 130 countries. The group published its findings today in the Journal of Clinical Oncology, a leading global cancer research journal.

“As health providers restart elective cancer surgery, they must look to protect cancer surgery patients from harm by investing in dedicated COVID-19 free hospital areas. These can be tailored to the resources available locally, ensuring patients treated for COVID-19 are not mixed with patients needing surgery,” said Collaborative lead Dr. Aneel Bhangu, from the National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, at the University of Birmingham.

The study, funded by a NIHR Global Health Research Unit Grant, covered adult patients undergoing elective surgery with curative intent for a range of suspected cancers including bowel, esophagus, stomach, head and neck, lung, liver, pancreas, bladder, prostate, kidney, womb, cervix, ovarian, breast, sarcoma and brain tumours.

Data included in this study represented a wide variety of different surgeries for patients of all ages, genders and ethnicities.

The countries participating in the study include: Argentina, Armenia, Australia, Austria, Azerbaijan, Barbados, Belgium, Brazil, Canada, Chile, Colombia, Croatia, Cyprus, Czech Republic, Denmark, Egypt, Ethiopia, Finland, France, Germany, Greece, Hong Kong SAR, China, Hungary, India, Ireland, Italy, Japan, Jordan, Libya, Madagascar, Malaysia, Mexico, Morocco, Netherlands, Nigeria, Oman, Pakistan, Peru, Poland, Portugal, Puerto Rico, Reunion, Romania, Russian Federation, San Marino, Saudi Arabia, Serbia, Singapore, Slovak Republic, South Africa, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States, Uruguay

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