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Mortality and pulmonary complications in patients undergoing upper extremity surgery at the peak of the SARS-CoV-2 pandemic in the UK: a national cohort study
  1. Benjamin John Floyd Dean
  2. The Corona Hands Collaborative
    1. Orthopaedic Surgery, Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
    1. Correspondence to Benjamin John Floyd Dean, Orthopaedic Surgery, Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford OX3 7LD, UK; bendean1979{at}


    Introduction This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2-related hospital processes at the peak of the first wave of the pandemic in the UK.

    Methods This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The secondary outcomes were SARS-CoV-2 complication rates and overall complication rates. A clinician survey relating to SARS-CoV-2 safety processes was carried out for each participating centre.

    Results This analysis includes 1093 patients who underwent upper limb surgery from the 1 to 14 April 2020 inclusively. The overall 30-day mortality was 0.09% (1 pre-existing SARS-CoV-2 pneumonia) and the mortality of day case surgery was zero. Most centres (96%) screened patients for symptoms prior to admission, only 22% routinely tested for SARS-CoV-2 prior to admission. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate was 6.6% (72 patients). Both SARS-CoV-2-related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive.

    Conclusions The SARS-CoV-2-related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing. Routine SARS-CoV-2 testing for day case upper limb surgery not requiring general anaesthesia may be excessive and have unintended negative impacts.

    • surgery
    • evaluation methodology
    • management
    • safety culture
    • standards of care

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    • Collaborators The Corona Hands Collaborative: Michael Elvey, Colin McDonald (University College London Hospitals NHS Foundation Trust); Michael Elvey, Anna Panagiotidou, John Hardman (London Northwest Healthcare NHS Trust); James Duncan, Ian McNab, Mike Lamyman, Catriona Luney, Stephen Gwilym, Daisy Ryan, Alistair Reed (John Radcliffe Hospital and Nuffield Orthopaedic Centre, Oxford); Dan Armstrong (University Hospitals of Derby and Burton); Maxim D Horwitz, Robert Macfarlane (Chelsea and Westminster Hospital NHS Foundation Trust); Chye Yew Ng, Ahsan Akhtar (Wrightington, Wigan and Leigh NHS Foundation Trust); Ryan W Trickett, Kathryn Dayananda (Cardiff and Vale University Health Board); Gillian L Eastwood, Ian McLaughlin Symon, Antonia Hoyle (Stepping Hill Hospital Stockport); S H Bostock, Chris Baldwin, Raveen L Jayasuriya, Helen Richards, Megan E Birks (Sheffield Teaching Hospitals, Northern General Hospital); Claire Simpson, Matthew Brown (St John’s Hospital, Livingston, West Lothian (NHS Lothian)); Simon M Johnson, Samuel Greensmith, Adam Couves (Ninewells Hospital Dundee and Perth Royal Infirmary, NHS Tayside); Alex J Nicholls, Zoe Lin (Hampshire Hospitals NHS Foundation Trust, Basingstoke); Dominic M Power, Bafiq Nizar (Birmingham Hand Centre, Queen Elizabeth Hospital Birmingham); Feiran Wu, Thomas Challoner (Heartlands, Good Hope and Solihull Hospitals, University Hospitals Birmingham); Tom Quick, Michael Fox, Kalpesh R Vaghela, Ashley Simpson (Royal National Orthopaedic Hospital, Stanmore); Suddhajit Sen (Noble’s Hospital; Isle of Man); Adrian Murphy, Matthew Torkington, Taegyeong Tina Ha, Helen Wohlgemut (Glasgow Royal Infirmary); Christian West, Stephen Lipscombe, Taegyeong Tina Ha, Carole Chan (St Helens and Knowsley NHS Trust, Whiston Hospital and St Helens Hospital); Claire Middleton, Shireen Ibish (Royal Berkshire Hospital, Reading); Jemma Rooker, Adam Smith (Great Western Hospital, Swindon); Clare J Wildin, Han Hong Chong, Mohamed Elbashir (University Hospital of Leicester NHS Trust); Clare Langley, Nicola Mackay (University Hospitals Coventry and Warwickshire); Duncan Avis, Rishi Das (Royal Hampshire County Hospital); Simon Robinson, Uthman Alao (Wirral University Teaching Hospital NHS Foundation Trust); Angus Maclean, Ullas Jayaraju (Royal Glamorgan Hospital, Llantrisant); Sue Fullilove, Juliana Hughes, Bruno Alcocer, Julia Sarginson (University Hospitals Plymouth); Oliver D Stone, Martin Shapev (Royal Devon and Exeter Hospital); David J Murray, Albert Tang (Pennine Acute Trust, North Manchester and Fairfield Hospitals); Ladan Hajipour, Imad Madhi (Wythenshawe Hospital); Saurabh Odak, Amit Singh (University Hospital Morecambe Bay NHS Foundation Trust); Fizan Younis, William Fletcher (Royal Blackburn Hospital); Soham Gangopadhyay, Sathishkumar Balasubramanian (South Tyneside district Hospital and Sunderland Royal Hospital); Andrew Smith, YS Cho (East Kent University Hospitals Foundation Trust); Jeremy Rodrigues, Ramesh Chennagiri, Matthew Baldwin, Murray Forsyth (Buckinghamshire Healthcare NHS Trust); Karanjit Mangat, Alexander Denning (Warwick Hospital, South Warwickshire NHS Foundation Trust); Sunil Garg (James Paget University Hospital, Great Yarmouth); Nasser Hyder, Nastaran Sargazi (Leighton Hospital, Crewe); Andrew McKee, Jonathan W M Jones, Mike Dunne (North West Anglia Foundation Trust (Peterborough City Hospital, Stamford Hospital and Hinchingbrooke Hospital)); Simon Wimsey, Rishi Dhir (Princess Alexandra hospital, Harlow); Edwin P Jesudason, Ravishanker Tangirala (Ysbyty Gwynedd Penrhosgarnedd, Bangor); Rob Poulter, Zulfiqar Ali Haider (Royal Cornwall Hospital NHS Trust, Truro); Hannah Lennox-Warburton, Suresh Srinivasan, Amr El Bahi (Kettering General Hospital); James G Warner, Alastair J Konarski (Royal Bolton Hospital); Onur Berber, Yueyang Li (Whittington Healthcare NHS Trust); James Henderson, Alasdair Bott, Sameer Gujral (Southmead Hospital, North Bristol NHS Trust); Alex Cowey, Cezary Kocialkowski (Royal United Hospital, Bath); Sami Hassan, Amin Kheiran (Northampton General Hospital); Neeraj Ahuja, Attila Nemeth (Southport and Ormskirk Hospital NHS Trust); Andy Hacker, Alex Martin (Milton Keynes General Hospital); Adrian Chojnowski, Martha Ricketts (Norfolk and Norwich University NHS Trust); Patrick Goon, Madeline Warren, Martinique Vella Baldacchino, Clarence Yeoh (Lister Hospital, Stevenage); Shwan Henari (Horton General Hospital); Robert Turner, Rakan Kabariti (Princess Royal Hospital, Shrewsbury and Telford NHS Trust); Mohamed A Imam, Anshul Sobti (Rowley Bristow Orthopaedic Centre, Ashford and St Peter’s NHS Trust); Claire Fitzgerald, Srinath Ranjit (Newham University Hospital, Barts Health NHS Trust); Noel Peter, Will Mason, Robyn Brown, Harry Akehurst (Cheltenham and Gloucester NHS Trust); Adeline Clement, Christopher Donoghue (Raigmore Hospital, Inverness (NHS Highland)); Aaron B Ng, Amy M Lindh (Pinderfields General Hospital); Grainne Bourke, Daniel J A Thornton, Joseph Stallard (Leeds General Infirmary); Ahid Abood, Nicholas G Rabey (Cambridge University Hospitals NHS Trust); David J Warwick, Michael J Newman (Royal South Hampshire Hospital, Southampton University Hospitals); David Lawrie, Alexandra EF Haddon (Aberdeen Royal Infirmary and Woodend Hospital, NHS Grampian); Edward Powell-Smith (Harrogate and District NHS Foundation Trust); Alexia Karantana, Sandeep Deshmukh (Nottingham University Hospitals NHS Trust); Harry Lewis, Serena Martin (Ulster Hospital, Northern Ireland); Sam Molyneux, Caitlin M Brennan (Royal Infirmary Edinburgh); Gavin Brigstocke, Joshua Luck (Frimley Park Hospital); Emma Reay, Christina Whitehead (James Cook University Hospital); Zakir Shariff, John Kiely (Bradford Teaching Hospitals NHS Foundation Trust); Matthew Torkington, Eoghan Donnelly (Queen Elizabeth University Hospital, Glasgow); Mohammed S Arshad, Pawan K Chajed (Royal Oldham Hospital); Gavan McAlinden, Rebecca Waterworth (South-Eastern HSC Trust); Ranjit Sehjal, Sheela Vinay (Maidstone and Tunbridge Wells NHS Trust); Benjamin J F Dean, Jonathan Cook, Andrew J Carr, Zachary Lim, Dominic Furniss (NDORMS, University of Oxford, Oxford); Nicholas Riley, Michelle Spiteri, Christopher Little (Nuffield Orthopaedic Centre, Oxford).

    • Contributors See attached appendix for full collaborative authorship information.

    • Funding BJFD is part funded by the BMA’s Doris Hillier grant.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data are available on reasonable request to the lead author.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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