Impact of Enhanced PeriOperative Care in restoring high-risk surgery at an acute tertiary hospital during the COVID-19 pandemic

Background: The COVID-19 pandemic led to an exceptional demand on critical care services and dramatic reduction in elective surgical capacity within our hospital, a large acute tertiary centre. To facilitate high-risk elective surgery and to ease pressure on our critical care unit (CCU), an Enhanced PeriOperative Care (EPOC) unit was established in June 2020. The EPOC service was set up within the framework and guidance offered by the Faculty of Intensive Care Medicine (FICM).1 We evaluated the impact of EPOC on restoring high-risk elective surgery. Methods: The frequency of elective surgical admissions between January 2019 and 2022 to CCU and EPOC were sourced through unit electronic records and logbook, respectively. Monthly COVID critical care admissions were also obtained through local ICNARC reporting. Results: COVID admissions to critical care peaked in January 2021 with 215 admissions in a single month. Before the pandemic, the CCU cared for an average of 175 high-risk elective surgical patients per month. This decreased to an average of 50 per month (April 2021–January 2022) after the second pandemic wave. Since April 2021, the average number of cases cared for on EPOC was 83 per month, which has brought the combined average (CCU and EPOC) to 133 per month (76% of pre-pandemic levels). Since inception (June 2020–January 2022), a total of 1208 high-risk elective cases have been facilitated by the EPOC (Fig. 10). Conclusions: Our EPOC service has been essential for the recovery of high-risk elective surgery after the COVID-19 pandemic. We hope that future planned expansion of the EPOC unit and improved access to critical care will help us to achieve at least pre-pandemic levels of surgical capacity. 1.Faculty of Intensive Care Medicine. Enhanced care: guidance on service development in the hospital setting 2020. Available from https://www.ficm.ac.uk/standardssafetyguidelinescriticalfutures/enhanced-care (accessed 5 February 2020)