Imperial College London
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MrAlexLiddle

Faculty of Medicine, Department of Surgery & Cancer

Clinical Senior Lecturer in Orthopaedics
 
 
 
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Contact

 

a.liddle Website

 
 
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Assistant

 

Miss Colinette Hazel +44 (0)20 7594 2725

 
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Location

 

203Sir Michael Uren HubWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Logishetty:2021:10.1302/2633-1462.22.BJO-2020-0200.R1,
author = {Logishetty, K and Edwards, TC and Subbiah, Ponniah H and Ahmed, M and Liddle, AD and Cobb, J and Clark, C},
doi = {10.1302/2633-1462.22.BJO-2020-0200.R1},
journal = {Bone & Joint Open},
pages = {134--140},
title = {How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic.},
url = {http://dx.doi.org/10.1302/2633-1462.22.BJO-2020-0200.R1},
volume = {2},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - AIMS: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. RESULTS: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 w
AU  - Logishetty,K
AU  - Edwards,TC
AU  - Subbiah,Ponniah H
AU  - Ahmed,M
AU  - Liddle,AD
AU  - Cobb,J
AU  - Clark,C
DO  - 10.1302/2633-1462.22.BJO-2020-0200.R1
EP  - 140
PY  - 2021///
SN  - 2633-1462
SP  - 134
TI  - How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic.
T2  - Bone & Joint Open
UR  - http://dx.doi.org/10.1302/2633-1462.22.BJO-2020-0200.R1
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33630719
UR  - https://online.boneandjoint.org.uk/doi/full/10.1302/2633-1462.22.BJO-2020-0200.R1
UR  - http://hdl.handle.net/10044/1/88151
VL  - 2
ER  -
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