Global guidance for surgical care during the COVID-19 pandemic

Abstract

Background: Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. Methods: A scoping search was conducted to identify published articles relating to management of surgical patients during pandemics. Key informant interviews were conducted with surgeons and anaesthetists with direct experience of working during infectious disease outbreaks, in order to identify key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic.Results: Thirteen articles were identified from the scoping search, and surgeons and anaesthetists representing 11 territories were interviewed. To mount an effective response to COVID-19, a pandemic response plan for surgical services should be developed in advance. Key domains that should be included are: provision of staff training (such as patient transfers, donning and doffing personal protection equipment, recognizing and managing COVID-19 infection); support for the overall hospital response to COVID-19 (reduction in non-urgent activities such as clinics, endoscopy, non-urgent elective surgery); establishment of a team-based approach for running emergency services; and recognition and management of COVID-19 infection in patients treated as an emergency and those who have had surgery. A backlog of procedures after the end of the COVID-19 pandemic is inevitable, and hospitals should plan how to address this effectively to ensure that patients having elective treatment have the best possible outcomes.

Screening with HRCT chest and PCR testing for COVID-19 in asymptomatic patients undergoing a surgical or diagnostic procedure

“…Since the outbreak of the coronavirus disease 2019 (COVID-19), measures have been taken to protect healthcare staff from infection, to prevent infection of patients admitted to the hospital and to distribute personal protective equipment (PPE) according to need 1 . To assure the proper protection without overuse of limited supply of PPE, screening of patients for COVID-19 before surgical or diagnostic procedure needs to be implemented 2,3 .…”

Management of patients with suspected COVID-19 who underwent emergency surgery

“…The preservation of medical staff is paramount in the management of patients with suspected COVID-19 to preserve the personnel to treat surgical emergencies and associated activities. The infection or selfisolation of senior surgeons due to COVID-19 exposure might result in a shortage of expertise within surgical teams [11,12]. If COVID-19 infection cannot be completely ruled out, the highest level of protection should be adopted.…”

“…The speci c transfer pathways and isolated recovery rooms, ICUs, or medical wards should be arranged well in advance. The use of electrocautery or ultrasonic scalpels should be limited (or the power settings lowered) as much as possible to reduce the risk of aerosol viral dispersal [12]. During the recovery phase, the present patients were cared for within the OR until direct transfer to the isolated inpatient ward for as short a time as possible to reduce the contact risk with the surrounding environment [16].…”

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

“…[7] Healthcare workers worked in teams with rotational duties to minimise COVID-19 infection among the healthcare workers. [8] As the occupational risk has increased, the providers are having to deal with ethical dilemmas, regarding their own safety, patients' condition and judicious use of the available resources. As a consequence, a natural selection of surgeries has been observed, despite all previous priority-settings and protocols.…”