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A Closer Look at COVID-19-Free Pathways in Elective Surgery

Op-Med is a collection of original articles contributed by Doximity members.

Dr. Zhen Gooi is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity. 

As the COVID-19 pandemic continues, health care systems continue to confront the dilemma of how best to utilize resources to provide care to infected patients, preserve capacity for surges, and continue treating other life-threatening illnesses. Cancer patients requiring surgery represent a population for which there is still an urgent need for medical intervention. 

In a recent study, researchers sought to compare the incidence of pulmonary complications and post-op COVID-19 infections among patients who received care in COVID-19-free pathways with patients who did not. A COVID-19-free pathway was defined as complete segregation of the OR, ICU, and inpatient units.

Patients who underwent surgery in COVID-19-free surgical pathways were younger and had fewer comorbidities. However, after adjusting for these differences, patients undergoing surgeries in COVID-19-free pathways still had lower post-op pulmonary complication rates. Further, post-op COVID-19 infections were lower in COVID-19-free surgical pathways.

The study results are interesting but limited by the low number of included patients (<30%) who had pre-op COVID-19 testing prior to surgery. It is highly possible that some of the observed post-op complications are attributable to patients who were asymptomatic with an undiagnosed COVID-19 infection before surgery. Additionally, the definition of a COVID-19-free pathway is not comprehensive. While the OR, ICU, and inpatient units may comprise a majority of patient care locations, there are other possible transmission avenues (e.g., the clinic, patient transport areas, and, critically, hospital personnel). 

The study’s conclusions advocate for the establishment of COVID-19-free surgical pathways — but strict adherence to PPE protocols and universal pre-op testing would be a more equitable and effective method of reducing nosocomial infections.

Dr. Zhen Gooi is a head and neck oncologic surgeon in academic practice at the University of Chicago. He completed his residency and fellowship training at Johns Hopkins University.

Illustration Collage by Jennifer Bogartz / Trofimchuk Vladimir / Shutterstock

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