The International Collaboration Helping Surgeons During Queensland’s Latest COVID Surge

As Queensland hospitals continue to battle through a third wave of COVID-19 this winter, surgeons can look to international collaborative research to understand the new risks of going ahead with surgery if their patient has recently had COVID-19.

Dr Philip Townend, Surgical Oncologist at Gold Coast University Hospital within the wider Gold Coast Health and Knowledge Precinct (GCHKP) understands the power of global collaboration in the medical community. Dr Townend is an Australian lead of ‘CovidSurg,’ the global initiative that seeks to understand the safety outcomes of surgery for people who have recently had COVID-19. It is a collaboration that has brought together medical teams from all over the world to share their patient surgery outcomes data, so surgeons can learn from others’ experiences, and make the best decisions on behalf of patients.

Patients diagnosed with COVID-19 who need surgery are a complicated group as COVID-19 infections can impact surgery outcomes and increase the risk of complications, such as blood clots and cardiac issues. Capturing real-world data and sharing international experience has helped to understand these risks – and to help make decisions about when it is safe to go ahead with surgery, or when surgery should be delayed.

Dr Townend said that Australian hospitals, including the Gold Coast University Hospital, have played a key role in multiple research studies related to the impact of COVID-19 on surgical patients and services, helping bridge communication in the global medical community.

It is a global collaboration that is still pointedly relevant to Dr Townend and Australian hospital teams today.

Global collaborations like CovidSurg share study data that informs important surgical decision-making in hospitals

When we spoke to Dr Townend in July, Queensland was experiencing a third COVID-19 wave, and many non-urgent surgeries were postponed; partly due to hospital workforce shortages and other service constraints – but also due to this understanding of the increased risk. Data from international networks, such as CovidSurg, has helped hospitals develop the policies, protocols, and guidelines for surgery during the pandemic.

“CovidSurg is a very diverse team of surgeons, clinicians, and medical students all collaborating to produce evidence to support surgical care decision-making during the pandemic. We have data from over 190,000 patients, from over 2,000 hospitals in 116 countries. There are 37 hospitals involved from Australia, including GCUH,” Dr Townend explained.

“It has been quite inspirational that we’ve been able to get this much data in such a short period. There are so many hospitals involved, and there are so many people within each hospital involved. I’ve had oncology nurses, hospital administrators, and medical students involved in various COVID-19 studies.”

“CovidSurg data has helped us manage our surgical patients and clarify the risks of a range of different operations. Now when we talk to the patients, we know that if they’ve had a recent COVID-19 infection they are often at higher risk of complications. We’ve got the data that we can say, ‘with this particular type of operation, this is the sort of risk that you’ve got.”

For example, key research findings included the following:

• Patients are at a much higher risk of complications in the first six weeks after COVID-19 infection.
• There is still increased risk of complications, even when patients do not have symptoms.
• Waiting until at least 7 weeks after a COVID-19 infection before surgery is recommended to return to normal levels of surgical risk.

“This is really important when we’re talking about informed consent, and also explaining why we might have to delay surgery for a couple of weeks, so the patient can understand that we’re trying to do what’s best for their health and safety.”

“Participation in CovidSurg not only set us up for global pandemic preparedness but it’s also made us realise the power of big data. Every single hospital and every single clinician that got involved could see the benefit.”

Australian hospitals played a key role in CovidSurg during the early stages of the pandemic

In the early months of the pandemic, Australian hospitals played an interesting role in CovidSurg research. Because of the country’s initial elimination strategy, Australian hospitals could provide valuable control data that could be compared to data from countries during their COVID-19 outbreaks to see the difference in risk.

“During that initial time, Australia was relatively isolated. We didn’t have a high volume of cases and the hospitals weren’t yet inundated with Coronavirus. It’s important when you do big research studies that you look at the haves and have-nots and compare them – that’s what we call a control group. The original research studies used our Australian data as a control group for the rest of the world.”

CovidSurg data helped informed public health guidelines – a lasting legacy for surgery patients and their doctors

CovidSurg data has since helped establish guidelines for what it’s like to operate after a COVID-19 infection and has provided evidence that reducing elective surgeries can help accommodate sick patients. Through a modelling study, findings also provided evidence to help predict staff shortages and stresses on the hospital system during a pandemic, information that is useful today in the face of continued disruptions to elective surgeries.

For Dr Townend, one of the most interesting learnings came from a CovidSurg study he undertook with a group of international surgeons about the impact of isolation on postoperative outcomes. While it might seem counter-intuitive to many, the study showed that for patients who were isolated before their surgery, there were negative impacts.

“Our isolation study looked at different groups of patients prior to having major operations and assessed whether socially isolating at home was a good thing. We found that if you isolate you can increase your post-surgery risk of complications such as pneumonia, which we were not expecting to find. It was a surprising find,” he said.

“The study showed that staying at home alone and not physically moving much, was not to the patient’s benefit – it did not protect them. Whereas getting outside for a walk in the fresh air was more beneficial as preparation for surgery.”

Collaboration amongst Precinct neighbours is also important to Dr Townend and his future research plans

Dr Townend is passionate about improving his patients’ overall care and experience, and in the background of the pandemic, he has also been researching a technology solution to reduce hospital administrative tasks and allow patients more 1:1 time with nurses and doctors. As the idea progresses in the future, Dr Townend plans to take advantage of the collaborative opportunities that the Lumina innovation community provides, such as the growing community environment for HealthTech startups in the Cohort Innovation Space.

“It’s early days working on the solution, however, I’d definitely like to collaborate with people who have been involved in other HealthTech startups about the operational side of things, such as corporate structures and investment strategies,” Dr Townend said.

“From what I can see already at Cohort Innovation Space and its surrounds, it looks like a little Silicon Valley already; Australia’s first Silicon Valley.”

“Everyone I’ve met at GCUH and around this area sees the potential at the Gold Coast, and I don’t think there’s any reason why the Gold Coast University Hospital can’t be an International Centre of Excellence in the next five years.