The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic
Authors: Van Den Heede K. , Chidambaram S. , Winter Beatty J. , Chander N. , Markar S. , Tolley N. S. , Palazzo F. F. , Kinross J. K. , Di Marco A. N. ,   the PanSurg Collaborative and the PREDICT‐Endocrine Collaborative, Beatty Jasmin Winter , Chidambaram Swathikan , Markar Sheraz , Kinross James K. , Di Marco Aimee N. , Kulshreshtha Ayush , Aseem Rabiya , Deurloo Emily K. , Quinnen Nicola C. , Cruz Nina J. M. DeLa , Yiu Andrew J. , Khan Natasha , Markiewicz Ola , Goh Ee Teng , Denning Max , Aggarwal Ravi , Mason Sam , Erridge Simon , Dryden Simon D. , Clarke Jonathan M. , Sounderajah Viknesh , Acharya Amish , Rabinowicz Simon , Yalamanchili Seema , Martin Guy , Warren Leigh , Scott Alasdair J. , Burgnon Elizabeth , Purkayastha Sanjay , Mechera Robert , Glover Anthony , Papachristos Alex , Xuan Rachel , Glover Anthony , Dhondt Bert , Azab Mohammed A. , Azzam Ahmed Y. , Balalis Dimitris , Fradelos Evangelos , Korkolis Dimitris P. , Skotsimara Antonia , Baili Efstratia , Kyros Eleandros , Felekouras Evangelos , Vagios Ilias , Karydakis Lyssandros , Mpoura Maria , Syllaios Athanasios , Davakis Spyridon , Liakakos Theodore , Charalabopoulos Alexandros , Fulop Andras , Szijarto Attila , Bhat Javeid , Parray Fazl , Aziz Gowhar , Chowdri Nisar , Wani Rauf , Shah Zameer , Andrabi Syed Muzamil , Mehraj Asif , Fowler Amy , Chaudhary Ali , Murphy Ben , van der Hoef Dayna , Ryan Eanna , O′Beirn Ellen , Marzouk Fadi , McKevitt Kevin , Nizami Kulsoom , Grewal Harleen , Hennessy Orla , Roden Yasmine , Elwahab Sami A. , Collins Christopher , Ayed Souad , Alwade Hajer , Aldaya Messedah , Magboul Nasir A. , Ali Alshahrani Mushabab , Ingwersen Ewout W. , Meijer Floor , Van Dijkum Els J. M. Nieveen , Voeten Daan M. , Gisbertz Suzanne S. , Van Berge Henegouwen Mark I. , Engelsman Anton F. , Yalcinkaya Ali , Sahin Can , Yavas Mesut , Yavuz Aydin , Gobut Huseyin , Bostanci Hasan , Sare Mustafa , Yuksel Osman , Kozan Ramazan , Altiner Saygin , Leventoglu Sezai , Kocataş Ali , Bozkurt Mehmet A. , Kara Yasin , Aybar Engin , Sari Ahmet Can , Colak Elif M. , Rooney Siobhan , Nandasena Malith , Balakrishnan Anita , De Jong Mechteld C. , Mihai Radu , Khan Shahab , Van Den Heede Klaas , Chander Nikita , Chidambaram Swathikan , Palazzo Fausto , Tolley Neil , Di Marco Aimee , Parkins Kristie , Spencer Naomi , Egan Richard J. 
Published: April 2021

Background

In the midst of the COVID‐19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice.

Methods

PanSurg‐PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT‐Endocrine collected endocrine‐specific data alongside demographics, COVID‐19 and outcome data from 11–3‐2020 to 13–9‐2020.

Results

A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety‐seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision‐making was affected by capacity, COVID‐19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID‐19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two‐thirds were asked to self‐isolate before surgery. There was one COVID‐19‐related ICU admission and no mortalities. Consultant‐delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post‐operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic.

Conclusion

The COVID‐19 pandemic has affected endocrine surgical decision‐making, case mix and personnel delivering care. Significant variation was seen in COVID‐19 risk mitigation measures. COVID‐19‐related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.