Safe Surgery During the COVID-19 Pandemic

Abstract

Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

Perceived stress level of the postoperative coronary artery bypass graft patients in the intensive care unit

“…This finding contrasts with a study which showed COVID-19 has had an enormous impact on patients needing surgery due to increased risk for patients and staff. [25] It would be reasonable to suggest that restrictive hospital COVID-19 protocols would have an impact on the stress level. However, it can be concluded that the high ranking of stress from restricted visitation of spouse, family, and friends was not due to the impact of COVID-19.…”

Controle de partículas aéreas nos procedimentos cirúrgicos durante a pandemia da Covid-19: revisão de escopo

“…Essas condutas ampliam a segurança para os pacientes e para equipe de saúde (34) . Portanto, as investigações (40)(41)(42) recomendam primeiramente realizar a triagem dos pacientes, com anamnese direcionada à identificação de sinais e sintomas da Covid-19. Além disso, recomendam também a realização de testes diagnósticos moleculares ou imunológicos e, quando não disponíveis em tempo hábil, a consideração do paciente como possível portador da Covid-19 (41)(42) .…”

“…Portanto, as investigações (40)(41)(42) recomendam primeiramente realizar a triagem dos pacientes, com anamnese direcionada à identificação de sinais e sintomas da Covid-19. Além disso, recomendam também a realização de testes diagnósticos moleculares ou imunológicos e, quando não disponíveis em tempo hábil, a consideração do paciente como possível portador da Covid-19 (41)(42) . Estudo (33) também recomenda a tomografia computadorizada de tórax como uma possibilidade suplementar na triagem do paciente.…”

“…No que diz respeito à modalidade cirúrgica, ou seja, cirurgia minimamente invasiva ou aberta, não há recomendações claras na literatura sobre qual técnica produz menos partículas aéreas (40)(41)(42)(43) . A literatura incluída identifica como procedimentos relacionados à alta produção de partículas aéreas as cirurgias torácicas, neurológicas, otorrinolaringológicas, maxilofaciais e laparoscópicas (20)(21)29) .…”

Control of airborne particles in surgical procedures during the Covid-19 pandemic: scoping review

“…As for the recommendations on surgical procedures, these range from the selection of the anesthetic modality, the adequate manipulation of the airways, to the execution of the surgical technique (12,(20)(21)24) . In the context of the Covid-19 pandemic, the main objective is to reduce the production and dispersion of With regard to the surgical modality, i.e., minimally invasive or open surgery, there are no clear recommendations in the literature on which technique produces fewer airborne particles (40)(41)(42)(43) . The included literature identifies thoracic, neurological, otorhinolaryngological, maxillofacial, and laparoscopic surgeries as procedures related to the high production of air particles (20)(21)29) .…”