Comments on: perioperative management of non-deferrable oncologic surgeries during COVID-19pandemic in Madrid, Spain. Is it safe?

To the Editor:

I would like to take the opportunity to comment on the interesting original article by Galipienzo et al.¹

First of all, I must thank the authors for reporting their surgical outcomes at such an opportune time. The disease caused by the new SARS-CoV-2 coronavirus has spread rapidly worldwide and is highly relevant, which is why it is so important to have access to evidence on surgical practice during these trying times. Issues such as prevention, detection, clinical management, and vaccination have modified our perception of and attitude towards health care. Nevertheless, the outcomes of surgery performed during the first wave are still interesting, because they show that surgery was safe even at the height of the Covid-19 pandemic.

In the first wave of Covid-19, the scant availability of critical care beds was one of the determining factors behind the cancellation of many major surgeries. Nevertheless, in Galipienzo et al.,¹ around 12% of patients were admitted to the surgical ICU, and the readmission rate was estimated at 1.5%. The author does not compare these figures with the pre-Covid sample, so it is unclear whether the rates of admission and re-admission were similar or lower than pre-pandemic rates.

In our hospital, 17.4% of patients undergoing 585 scheduled complex surgery during the peak of the first Covid-19 were admitted to the surgical ICU, a percentage that was significantly lower than the 29% of patients with similar characteristics admitted to the surgical ICU in the pre-Covid era.² No significant differences were observed between groups in terms of surgery-related adverse events (Clavien–Dindo 3-5), indicating that the shortage of ICU beds during a pandemic can be relativised by only performing unavoidable surgeries, such as cancer surgeries or interventions in patients at high risk of dying on a waiting list.

Finally, I would like to point out that, despite the best intentions, in order to compare pre-pandemic and intra-pandemic surgical outcomes using non-inferiority criteria, greater precision is needed in both sample selection (determining case complexity using clinical and surgical risk scores) and statistical methodology. This methodological rigour is needed to show that the pandemic did not have a negative impact on surgical outcomes in terms of morbidity and mortality when both patient and healthcare worker protection protocols were implemented correctly.