TY - JOUR T1 - Can we safely continue to offer surgical treatments during the COVID-19 pandemic? JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 268 LP - 270 DO - 10.1136/bmjqs-2020-012544 VL - 30 IS - 4 AU - Alex Fowler AU - Tom E F Abbott AU - Rupert M Pearse Y1 - 2021/04/01 UR - http://qualitysafety.bmj.com/content/30/4/268.abstract N2 - The coronavirus pandemic has caused enormous disruption to routine healthcare in many countries, with large numbers of patients requiring hospital treatment for COVID-19.1 In the UK National Health Service (NHS) many routine care pathways were rapidly suspended to redeploy staff, hospital beds and equipment to handle the massive influx of patients. Surgical procedures were cancelled for all but the most urgent cases.2 In this issue of BMJ Quality and Safety, the Corona Hands Collaborative group report the results of a cohort study conducted over a 2-week period in April 2020, during the peak of the first wave of the COVID-19 pandemic in the UK.3 Data were collected for 1093 patients undergoing upper limb surgery in 74 NHS hospitals. A clinician survey captured data describing surgical cancellations, operating room capacity and infection control procedures at each hospital. The principal finding was that, in this patient population, the risk of death within 30 days after surgery was very low (<0.1%). While 19 patients were diagnosed with COVID-19, only one patient died, and the reported postoperative complications match the expected pattern for upper limb surgery. The authors conclude that low-risk surgery can be safely delivered in the context of the pandemic.In any observational study, an important source of bias is misclassification of the exposure or patient outcome. In this case, the identification of patients with SARS-CoV-2 infection and diagnosis of COVID-19 warrants discussion. SARS-CoV-2 is a virus, which requires a test (usually viral PCR) to identify it. Infection with SARS-CoV-2 can be symptomatic or asymptomatic. COVID-19 is the clinical disease caused by infection with SARS-CoV-2 and, in some situations, can be diagnosed without a positive SARS-CoV-2 test result.4 Due to the limited availability of SARS-CoV-2 testing early in the pandemic, the authors’ definition of SARS-CoV-2 included patients … ER -