Proposed delay for safe surgery after COVID‐19

Abstract

Background Long‐term effects after COVID‐19 may affect surgical safety. This study aimed to evaluate the literature and produce evidence‐based guidance regarding the period of delay necessary for adequate recovery of patients following COVID‐19 infection before undergoing surgery. Methods A rapid review was combined with advice from a working group of 10 clinical experts across Australia and New Zealand. MEDLINE, medRxiv and grey literature were searched to 4 October 2020. The level of evidence was stratified according to the National Health and Medical Research Council evidence hierarchy. Results A total of 1020 records were identified, from which 20 studies (12 peer‐reviewed) were included. None were randomized trials. The studies comprised one case–control study (level III‐2 evidence), one prospective cohort study (level III‐2) and 18 case‐series studies (level IV). Follow‐up periods containing observable clinical characteristics ranged from 3 to 16 weeks. New or excessive fatigue and breathlessness were the most frequently reported symptoms. SARS‐CoV‐2 may impact the immune system for multiple months after laboratory confirmation of infection. For patients with past COVID‐19 undergoing elective curative surgery for cancer, risks of pulmonary complications and mortality may be lowest at 4 weeks or later after a positive swab. Conclusion After laboratory confirmation of SARS‐CoV‐2 infection, minor surgery should be delayed for at least 4 weeks and major surgery for 8–12 weeks, if patient outcome is not compromised. Comprehensive preoperative and ongoing assessment must be carried out to ensure optimal clinical decision‐making.

Utilizing Google Trends to Track Online Interest in Elective Hand Surgery During the COVID-19 Pandemic

“…The exact reason as to why the search trends returned to baseline even with the subsequent COVID-19 waves cannot be fully elucidated given the nature of the retrospective study design. It is likely, however, that with the initiation of COVID-19 protocols in hospitals and surgery centres, elective cases could once again proceed in a safe fashion [3][4][5][6]. This might explain why search interest in elective hand surgery returned to baseline even with the rising COVID-19 cases in July and fall of 2020.…”

“…As the number of COVID-19 infections continues to grow worldwide, data on the impact of delayed medical and surgical care on patient-related morbidity and mortality are emerging [ 3 , 4 ]. In this study, we found that online interest in elective hand surgery remained constant from the fall of 2019 to early March 2020; however, there was a marked decrease in search trends of elective hand surgery with the sudden rise in daily reported COVID-19 cases in mid-March 2020, suggesting that interest in elective hand surgery decreased with the onset of the COVID-19 pandemic.…”

“…The COVID-19 pandemic has had an unprecedented effect on health-care utilization of both emergent and elective procedures and posed an important challenge in the perioperative and postoperative management of the surgical patient. With the extraordinary burden that health-care systems nationally and globally are experiencing as a result of the pandemic, many elective surgical cases, including orthopaedic hand surgeries, have been delayed or withheld [3][4][5][6].…”

Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change

“…Surgery on patients infected with SARS-CoV-2 may cause postoperative morbidity and mortality 3 , 4 , and this should be understood for preoperative risk–benefit assessment. Adequate delay after infection should be allowed to ensure safety for patients undergoing elective procedures 62 , 63 . Operations on COVID-19 patients should ideally occur in designated theatres with negative-pressure ventilation 12 , and suspected COVID-19 patients should wear a surgical mask during perioperative theatre transport 21 .…”

Quality of YouTube Videos on Laparoscopic Cholecystectomy for Patient Education

“…Minimally Invasive Surgery e management of surgical systems has been modified considerably at many points during the current COVID-19 pandemic [15]. Recent evidence suggests that some of these changes may need to be enduring to ensure surgical safety as COVID-19 continues to spread [16]. roughout this adaptation process, the quality of the patient education process must be maintained, particularly for high-volume procedures such as laparoscopic cholecystectomy.…”