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.