• Daniel J Boffa, Benjamin L Judson, Kevin G Billingsley, Erin Del Rossi, Kasey Hindinger, Samantha Walters, Theresa Ermer, Elena Ratner, Marci R Mitchell, Maxwell S Laurans, Dirk C Johnson, Peter S Yoo, John M Morton, Holly B Zurich, Kimberly Davis, and Nita Ahuja.
• Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut.
• Ann. Surg. 2020 Dec 1; 272 (6): e316-e320.

ObjectiveThe outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic.Summary Of Background DataCrucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a "COVID-minimal pathway" was created.MethodsPatients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The "COVID-minimal surgical pathway" consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections.ResultsAfter implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56-79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1-6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection.ConclusionsA COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.

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