Surgical and operating room procedures during the COVID-19 pandemic (multiple reviews)
What is this? The COVID-19 pandemic is affecting the provision of surgery for patients and several relevant reviews have been done. More details of these, including citations and links to their full text are available further down this summary.
What was found:
Recommendations for practices relevant to the conduct of surgery include the use of pre-operative planning, negative pressure ventilation in operating theatres, limited personnel, single-use equipment, designated donning and doffing areas, dedicated COVID-19 theatres and teams and COVID-free facilities, use of regional anaesthesia to minimise duration of surgery, limited use of electro-cauterization within procedures, limiting the use of endoscopic procedures to emergencies and selected suspected or confirmed cancer patients, and telemedicine for postoperative follow-up.
Recommendations for staff involved in surgery include use of appropriate personal protective equipment (PPE), training, screening, showers following procedures and the provision of psychological support.
Recommendations for surgery patients include screening for SARS-CoV-2, self-isolation before elective admission and the use of surgical masks during admission.
In the Eichberg review (search done on 5 April 2020) of neurosurgery, remote telemedicine was found to be feasible for patients in the pre-hospital, inpatient, outpatient and transfer triage settings, at least in resource-scarce situations.
The Lee review (search done on 1 July 2020) found that most studies which followed the health of surgical workers noted no adverse outcomes with proper safety measures including PPE and effective screening and isolation post-operatively. At the time of the review, there was limited information on postoperative complications during pandemics and no information on the clinical impact of delaying surgical care during lockdowns.
What are the reviews:
Citation: De Simone B, Chouillard E, Di Saverio S, et al. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. The Annals of The Royal College of Surgeons of England. 2020;102(5):323-32.
In this rapid review, the authors searched for articles on COVID-19 and surgery in an emergency setting. They restricted their searches to articles published in English between 15 December 2019 and 30 March 2020. They included 12 articles.
Citation: Eichberg DG, Basil GW, Di L, et al. Telemedicine in neurosurgery: lessons learned from a systematic review of the literature for the COVID-19 era and beyond. Neurosurgery. 2021;88(1):e1-e12.
In this systematic review, the authors searched for literature describing telemedicine in the context of neurosurgery. They restricted their searches to articles published from 1995 to 2020 in English and their last literature search was done in April 2020. They included 52 studies (45,801 patients).
Citation: Hojaij FC, Chinelatto LA, Boog GH, et al. Surgical Practice in the Current COVID-19 Pandemic: A Rapid Systematic Review. Clinics. 2020;75:e1923.
In this rapid review, the authors searched for research or recommendations regarding surgery dynamics, screening of patients and elective procedures during the COVID-19 pandemic. They did not restrict their searches by date, type or language of publication and did the search on 4 April 2020. They included 21 research articles, 5 opinion articles, 4 editorials and 9 other articles.
Citation: Lee Y, Kirubarajan A, Patro N, et al. Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review. American Journal of Surgery. 2020 Nov 12.
In this rapid review, the authors searched for studies that assessed postoperative outcomes or protection measures for surgical staff during pandemics. They did not restrict their searches by date or language of publication and did the search on 1 July 2020. They included 61 studies (3948 patients across 17 countries), 56 of which related directly to the COVID-19 pandemic. They also included studies of SARS (3), MERS (1) and Ebola (1).
Citation: Pavan N, Crestani A, Abrate A, et al. Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era. European Urology Focus. 2020; 6(5):1058-69.
In this rapid review, the authors searched for clinical and pre-clinical studies evaluating the risk of viral transmission to healthcare workers from any surgical treatment of patients with a viral disease, or studies evaluating the presence of virus remnants in surgical smoke. They did not restrict their searches by language of publication and did the search on 2 April 2020. They included 14 clinical studies, 8 pre-clinical studies and 2 papers reporting both clinical and pre-clinical study data.
Citation: Soltany A, Hamouda M, Ghzawi A, et al. A scoping review of the impact of COVID-19 pandemic on surgical practice. Annals of Medicine and Surgery. 2020;57:24-36.
In this rapid review, the authors searched for studies of the impact of the COVID-19 pandemic on surgical practice and training or guidelines for surgical practice from accredited institutions or professional associations. They restricted their searches to articles published in English from December 2019 to mid-June 2020. They included 66 articles and reports from North America, South America, Europe and Asia (with most being from the USA).
Citation: Spolverato G, Capelli G, Restivo A, et al. The management of surgical patients during the COVID-19 pandemic. Surgery. 2020;168(1):4-10.
In this rapid review, the authors searched for research or opinion papers on the epidemiology and diagnosis of COVID-19, the management of cancer and surgical patients, and the safety of healthcare workers during the pandemic. They did not restrict their searches by type or language of publication and searched for articles published between January 1998 and 2 April 2020. They included 28 retrospective studies.
Citation: Welsh Surgical Research Initiative (WSRI) Collaborative. Recommended operating room practice during the COVID‐19 pandemic: systematic review. BJS Open. 2020;4(5):748-56.
In this rapid review, the authors searched for research or recommendations for operating room practices during the COVID-19 pandemic. They did not restrict their search by date, type or language of publication and did the search on 19 March 2020. They included 9 expert opinion articles and 2 observational studies. These were from China (9 articles) and Singapore (2).
Other reviews relevant to this topic:
Citation: Goyal T, Harna B, Taneja A, et al. Arthroscopy and COVID-19: Impact of the pandemic on our surgical practices. Journal of Arthroscopy and Joint Surgery 2020;7(2):47-53.
Citation: Patterson TJ, Currie PJ, Beck J, et al. A systematic review of viral transmission risk to healthcare staff comparing laparoscopic and open surgery. The Surgeon. 2020;18(6):e72-7.