General surgery and COVID-19: review of practical recommendations in the first pandemic phase

Abstract

Background In March, 2020, the World Health Organization declared COVID-19 a pandemic. The absence of previous knowledge of COVID-19 has made decision-making difficult for all in health care, including surgical departments. We reviewed the management recommendations for surgical activity and changes to surgical practice, identifying concordances and discrepancies, based on the literature published in the early phase of the pandemic. Method We searched the electronic datasets, PubMed Database, Google, and Google Scholar, using the keywords “SARS-CoV-2”, “COVID-19”, “surgery”, “recommendations”, “guideline”, and “triage”. The search was limited to the first 2 months after the pandemic began and was closed on May 6, 2020. Results Twenty papers were included in the analysis and their recommendations are divided into the following categories: 1. general aspects, such as maintaining the safety of health personnel and indications for surgery. 2. The preoperative phase, with recommendations about activating different care pathways for COVID-19 positive patients. 3. The operative phase, with recommendations about activating safety measures for aerosol-generating procedures. 4. The postoperative phase, with recommendations for managing operating theatres and patient transfers. Conclusion The recommendations proposed in the revised documents are considered good practices aimed at keeping patients and healthcare professionals safe. However, these recommendations must be contextualized in each individual hospital.

Mechanism and transmission routes of COVID-19

“… 101 , 102 Also, care should be taken during surgery and blood transfusion to make sure the donor is uninfected. 103 Special care on personal protection of patients and health care professionals particularly in the outpatient departments (OPD) are mandatory.…”

Continuity of Cancer Care: The Surgical Experience of Two Large Cancer Hubs in London and Milan

“…Various studies have reported an important decrease in cancer referrals, creating a concern that many cancer patients had a delay in their diagnosis and treatment, resulting in further advancement of their disease [ 6 , 7 ]. Moreover, a recent meta-analysis found that a delay in surgical cancer treatment of four weeks is associated with a 6–8% increase in the risk of death [ 8 ]. Another recent cohort study also reported that substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK [ 9 ].…”

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“…Since then, the spread of COVID-19 has affected the socioeconomic and healthcare systems of many countries, including Japan (Supplementary Fig. 1) [4][5][6][7][8][9]. Elderly people are reportedly more susceptible to COVID-19 with higher mortality rates.…”