Swift and decisive actions on the part of healthcare and hospital authorities are required to effectively contain the current COVID-19 pandemic. These measures firstly allow personnel and facilities leeway to provide surge capabilities to meet anticipated increased demands on the healthcare service. In addition, by deferring none urgent hospital visits, admissions and investigations, such measures support social distancing and aid attempts to control disease transmission. Deferring perceived non-urgent patient services may however lead to unintended delayed diagnoses and exacerbation of current patient conditions and lead to increased emergency admissions and surgeries.

A policy decision was made that essential surgical services pertaining to cancer and urgent cardiovascular surgery were allowed but that surgeons had the option to postpone what is assessed to be less urgent cases. Increasingly patients also postpone their surgeries or visits because of anxieties over the developing situation. Elective surgical services at the Outram Campus were thus significantly reduced from January 2020 as part of the measures to contain the COVID-19 outbreak.

The surgical philosophy during this period was that a judicious policy that allowed surgeons to proceed with surgery deemed critical but to postpone those deemed less so will at the system level, avoid poor outcomes for patients who required surgery and yet successfully re-allocate resources required to address the unfolding pandemic.

Cohort of patients who were treated will be analysed via retrospective medical records review. These patients are classified according to the institution, type of surgical procedures, the medical condition and the dates of surgical treatment. The study will be compared across four time periods as listed:

-1Jan-31Dec2020 -1Jan-31Dec2019 -1Jan-31Dec2018 -1Jan-31Dec2017

The study focus on surgical indices for selected high-volume cancer and non-cancer diagnoses over the period 1st January 2020 to 31 December 2020 and compare them with similar indices across the same period of time in the preceding 3 years in particular, for the following surgical procedures:

1. Surgeries for the following cancer diagnoses:

   1. breast cancer, [XIV- N60, no malignancy], [Malignant, II Neoplasms- C50], colorectal cancer, [C18, 19, 20],
   2. hepatocellular carcinoma, [C22]

2. Selected non-cancer surgeries: a. Cholecystectomy b. Abdominal hernia repair

Inclusion Criteria:

• Patients who had the following surgeries during the period 01 Jan 2017 to 31 December 2020.

From the identified surgical procedure type as shown Surgeries for the following cancer-related procedures.

1. Breast Cancer
2. Colon Cancer
3. Liver
4. Rectum

Selected non-cancer surgeries.

1. Abdominal Wall
2. Gall bladder

Patients from SGH and its releated institute NCC Only local Singapore citizens

Exclusion Criteria:

No exclusion criteria

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All patients coming to SGH for surgeries