Recommended operating room practice during the COVID-19 pandemic: systematic review

Abstract

Background: The COVID-19 pandemic poses a critical global public health crisis. Operating room (OR) best practice in this crisis is poorly defined. This systematic review was performed to identify contemporary evidence relating to OR practice in the context of COVID-19.Methods: MEDLINE was searched systematically using PubMed (search date 19 March 2020) for relevant studies in accordance with PRISMA guidelines. Documented practices and guidance were assessed to determine Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence, and recommendations for practice within five domains were extracted: physical OR, personnel, patient, procedure, and other factors.Results: Thirty-five articles were identified, of which 11 met eligibility criteria. Nine articles constituted expert opinion and two were retrospective studies. All articles originated from the Far East (China, 9; Singapore, 2); eight of the articles concerned general surgery. Common themes were identified within each domain, but all recommendations were based on low levels of evidence (median OCEBM level 5 (range 4-5)). The highest number of overlapping recommendations related to physical OR (8 articles) and procedural factors (13). Although few recommendations related to personnel factors, consensus was high in this domain, with all studies mandating the use of personal protective equipment.Conclusion: There was little evidence to inform this systematic review, but there was consensus regarding many aspects of OR practice. Within the context of a rapidly evolving pandemic, timely amalgamation of global practice and experiences is needed to inform best practice.

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 . Besides surgery on a COVID-19 patient posing a risk to the treatment team, it can also be detrimental to the post-operative course of COVID-19 for the patient 3 .…”

“…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 . Besides surgery on a COVID-19 patient posing a risk to the treatment team, it can also be detrimental to the post-operative course of COVID-19 for the patient 3 . Longer surgery time and more difficult procedures are predictors of more complicated disease progression, together with age and comorbidity.…”

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process

“…Operating room (OR) practice, like many aspects of the response to COVID-19, has been driven predominantly by basic principles and shared experience, in the absence of a reliable evidence base 3 . Wide variation in practice is therefore predictable, and early clinical guidance is disproportionately reliant on the expert opinion of small committees [4][5][6][7][8] .…”

“…Although beneficial in aligning early OR practice, such leadership cannot hope to integrate the perspectives of the wider medical community. Moreover, contemporary research methods appear of limited use when confronted with serious, changing and evidence-poor states 3 . The aim of this study was to identify the knowledge needs of the global OR workforce, to characterize the available supporting evidence, and to establish consensus by means of a rapid modified Delphi process to inform safe surgical practice.…”

International surgical guidance for COVID-19: Validation using an international Delphi process - Cross-sectional study

“…International professional bodies have been quick to disseminate initial guidance documents during the COVID-19 pandemic [3][4][5]. In the absence of firm evidence [6], and with insufficient time to consult their memberships, guidance has been based predominantly on experiential reports and has been developed by expert committees within these professional bodies; limited in participant number, yet farreaching in influence [7]. Such leadership, while helpful in aligning early OR practice, is not comprehensive, and cannot hope to integrate the perspectives of the wider medical community.…”