Abstract

INTRODUCTION

On December 31, 2019, a cluster of patients with pneumonia of unknown cause was reported in China (¹1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017.
https://doi.org/10.1056/NEJMoa2001017... ). These cases were epidemiologically linked to a seafood and wet animal wholesale market in Wuhan, Hubei Province. Further analysis through unbiased sequencing and isolation of airway epithelial cells revealed a previously unknown betacoronavirus, named 2019-nCOV (2019 novel coronavirus), which became the seventh member of the family of coronaviruses that infect humans (²2. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. https://doi.org/10.1016/j.jaut.2020.102433.
https://doi.org/10.1016/j.jaut.2020.1024... ). Early reports suggested the onset of a potential coronavirus outbreak because of the high reproduction number. By the end of January 2020, 7,734 cases were confirmed in China, with 90 others being reported in other countries including Thailand, Vietnam, Malaysia, Nepal, Sri Lanka, Japan, Republic of Korea, United States, India, Australia, Canada, France, and Germany. At this time, the World Health Organization (WHO) declared a Public Health Emergency of International Concern. On April 4, 2020, the most recent date covered by this review, the WHO reported 1,051,697 confirmed cases and 56,986 deaths in 207 countries affected by the epidemic (³3. World Health Organization. Coronarivus disease 2019 (COVID-19) Situation Report - 75. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200404-sitrep-75-covid-19.pdf?sfvrsn=99251b2b_4 [cited Apr 11th, 2020]
https://www.who.int/docs/default-source/... ), after coronavirus disease (COVID-19, named by the WHO on February 11, 2020) was declared a global pandemic on March 11, 2020 (⁴4. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 51. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 [cited Apr 11th, 2020]
https://www.who.int/docs/default-source/... ).

COVID-19 was revealed to be a complex disease. Its replication rate (R0) of 2.0-3.0, death rate of approximately 5%, and the absence of immunological memory in humans, together with the time of adaptation for disease screening and notification, led to a rapid growth in the numbers of infected individuals worldwide (⁴4. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 51. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 [cited Apr 11th, 2020]
https://www.who.int/docs/default-source/... ,⁵5. Gt Walker P, Whittaker C, Watson O, Baguelin M, Ainslie KEC, Bhatia S, et al. The Global Impact of COVID-19 and Strategies for Mitigation and Suppression. Available from: https://doi.org/10.25561/77735 [cited Apr 11th, 2020]
https://doi.org/10.25561/77735... ). This phenomenon brought the attention to the greatest challenge posed by this disease: the high demand for health-care services versus the capability of health-care systems (⁵5. Gt Walker P, Whittaker C, Watson O, Baguelin M, Ainslie KEC, Bhatia S, et al. The Global Impact of COVID-19 and Strategies for Mitigation and Suppression. Available from: https://doi.org/10.25561/77735 [cited Apr 11th, 2020]
https://doi.org/10.25561/77735... ). The rapid growth in the numbers of infected individuals has drastically increased the demand for health services, which has led to social and health-care adaptations, ranging from social distancing to the reformulation of health-care delivery (⁶6. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 74. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200403-sitrep-74-covid-19-mp.pdf?sfvrsn=4e043d03_14 [cited April 11th, 2020]
https://www.who.int/docs/default-source/... ).

In this context, surgery is one of the areas facing the need for many adaptations. In many places, elective surgeries are preferably postponed and urgent/emergency surgeries - such as surgery for trauma and complicated hernias - are continued with some alterations (e.g., reducing the number of surgical staff and modifying the organization of the operating room) (⁷7. SAGES and EAES Recommendations Regarding Surgical Response to COVID-19 Crisis - SAGES. Available from: https://www.sages.org/recommendations-surgical-response-covid-19/ [cited Apr 6th, 2020]
https://www.sages.org/recommendations-su... 8. Brindle M, Gawande A. Managing COVID-19 in Surgical Systems. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000003923
https://doi.org/10.1097/SLA.000000000000... 9. Burke JF, Chan AK, Mummaneni V, Chou D, Lobo EP, Berger MS, et al. Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm. Neurosurgery. 2020. pii: nyaa116. https://doi.org/10.1093/neuros/nyaa116
https://doi.org/10.1093/neuros/nyaa116... 10. Ramirez PT, Chiva L, Eriksson AGZ, Frumovitz M, Fagotti A, Gonzalez Martin A, et al. COVID-19 Global Pandemic: Options for Management of Gynecologic Cancers. Int J Gynecol Cancer. 2020. pii: ijgc-2020-001419. https://doi.org/10.1136/ijgc-2020-001419.
https://doi.org/10.1136/ijgc-2020-001419... ). Many societies and authors have published different guidelines with respect to surgical protocols in this pandemic situation. In this review, we aimed to analyze different perspectives concerning this situation, with the objective of providing recommendations that could guide surgeons and entities toward screening, elective and emergency surgeries, decision making, and operating room management.

MATERIAL AND METHODS

We performed a systematic literature review based on an online search in the PubMed (from the National Center for Biotechnology Information), Scientific Electronic Library Online (SciELO), and Scopus databases. The following terms were used in the search engine to find matching articles: (OPERATION OR SURGERY) AND (SARS-COV-2 OR COVID-19 OR CORONAVIRUS). Our initial search yielded 281 articles. Other articles sent to the authors by societies or colleagues were also included in the sample (n=15). Duplicates were initially deleted using the Endnote (Clarivate Analytics) reference engine. Articles that were not in English (Portuguese, Spanish, or German) were translated using online translation service. All article titles and abstracts were read by at least one author, and selected if relevant. For this review, an article was considered relevant if it (a) is related to the COVID-19 pandemic, (b) suggested approaches directly affecting surgery dynamics (e.g., reducing staff numbers, remodeling the circulation of staff and patients in the operating room, using different protection methods for patients and staff, and adapting different equipment usage), (c) suggested any kind of screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for surgical patients, or (d) had any kind of recommendation about elective procedures. Papers focused on anesthetics and general hospital management were excluded.

For the articles selected for full-text reading, at least two authors read the contents. If those authors disagreed about including an article in our review, a third author read the paper to arrive at a consensus.

Data analysis was performed using the Google Sheets application (Google Inc.).

RESULTS

Records

Of the 281 articles found in our initial search and 15 articles from alternative sources, 39 were included in our review after a systematic evaluation (Figure 1). Of the 39 selected publications, 21 were research articles, 5 were opinion papers, 4 were editorials, and 9 were grouped as “others” (Figure 2).

Most of the articles were related to surgical interventions in the gastrointestinal tract, followed by articles on head and neck and general surgeries. Other, less frequent, surgeries were vascular, trauma, oral and maxillofacial and thoracic (Figure 3).

COVID-19 Screening

Twenty-nine articles recommended screening for SARS-CoV-2 in patients elected for surgery (Figure 4). The most prevalent recommendation was to perform polymerase chain reaction (PCR) testing of nasal swabs in all surgical patients. Other suggestions included screening through computed tomography, clinical examination, temperature measurement, and measurement of immune cells in blood samples, as well as testing only symptomatic patients (Figure 5).

Surgical Recommendations

With respect to surgical schedules, a little fewer than one-half of the articles recommended postponing all elective surgeries (Figure 6). Another prevalent suggestion was to select, from the group of elective surgeries, those that could be postponed. Around 13% of the articles did not offer any direct recommendations with respect to elective surgeries.

The articles also offered recommendations about surgical practice, including reorganization of the operating room schedule to provide only essential surgical services, guaranteeing psychological support to surgical staff, increasing protective measures to level 3 standards, and utilizing telemedicine for consultations that do not require physical evaluation. Table 1 summarizes the 10 most frequent and relevant recommendations and the article(s) that suggested them. (Note: Not all recommendations are included in the table.)

DISCUSSION

The coronavirus pandemic is an unprecedented scenario for the field of surgery. Surgery for high-risk cases cannot be postponed; however, the SARS-CoV-2 virus has a high transmissibility and techniques that could allow surgeons to perform safer surgeries in the operating room are warranted.

Isolation is impossible to practice in the operating room because an anesthetist has to stand close to the patient to adequately perform intubation (⁴⁰40. Xu K, Lai XQ, Liu Z. [Suggestions for prevention of 2019 novel coronavirus infection in otolaryngology head and neck surgery medical staff]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;55(0):E001. https://doi.org/10.3760/cma.j.issn.1673-0860.2020.0001
https://doi.org/10.3760/cma.j.issn.1673-... 41. Dai FQ, Guo W, Deng B, Tao SL, Jiang B, Wang YJ, et al. [Suggestions for thoracic surgery clinical practice in non-epidemic area of 2019 coronavirus disease]. Zhonghua Wai Ke Za Zhi. 2020;58(4):273-7. https://doi.org/10.3760/cma.j.cn112139-20200219-00100.
https://doi.org/10.3760/cma.j.cn112139-2... 42. Donnally CJ 3rd, Shenoy K, Vaccaro AR, Schroeder GD, Kepler CK. Triaging Spine Surgery in the COVID-19 Era. Clin Spine Surg. 2020. https://doi.org/10.1097/BSD.0000000000000988
https://doi.org/10.1097/BSD.000000000000... 43. Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000003925
https://doi.org/10.1097/SLA.000000000000... 44. Gori A, Dondossola D, Antonelli B, Mangioni D, Alagna L, Reggiani P, et al. Coronavirus disease 2019 and transplantation: A view from the inside. Am J Transplant. 2020. https://doi.org/10.1111/ajt.15853
https://doi.org/10.1111/ajt.15853... 45. Chan JYK, Wong EWY, Lam W. Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. 2020. https://doi.org/10.1001/jamaoto.2020.0488
https://doi.org/10.1001/jamaoto.2020.048... 46. De Felice F, Petrucciani N. Treatment approach in locally advanced rectal cancer during coronavirus (COVID-19) pandemic: long course or short course? Colorectal Dis. 2020. https://doi.org/10.1111/codi.15058
https://doi.org/10.1111/codi.15058... 47. Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, et al. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir. 2020. https://doi.org/10.1007/s00701-020-04305-w
https://doi.org/10.1007/s00701-020-04305... ), which increases the exposure to aerosols that may be contaminated by the virus. Further, the virus also spreads through biological fluids, thus compromising the safety of the surgical environment in most cases.

Methods used to reduce contact have been suggested. Laparoscopies have been considered as a good way to diminish risks, because, in theory, a closed abdomen, which prevents the spread of gas or liquid, would decrease the possibility of contamination (³⁶36. Yu GY, Lou Z, Zhang W. [Several suggestion of operation for colorectal cancer under the outbreak of Corona Virus Disease 19 in China]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(3):9-11. https://doi.org/10.3760/cma.j.issn.1671-0274.2020.03.002.
https://doi.org/10.3760/cma.j.issn.1671-... 37. Li X, Liu M, Zhao Q, Liu R, Zhang H, Dong M, et al. [Preliminary Recommendations for Lung Surgery during 2019 Novel Coronavirus Disease (COVID-19) Epidemic Period]. Zhongguo Fei Ai Za Zhi. 2020;23(3):133-5. https://doi.org/10.3779/j.issn.1009-3419.2020.03.01.
https://doi.org/10.3779/j.issn.1009-3419... 38. Zhao S, Ling K, Yan H, Zhong L, Peng X, Yao S, et al. Anesthetic Management of Patients with COVID 2019 Infections during Emergency Procedures. J Cardiothorac Vasc Anesth. 2020;34(5):1125-31. https://doi.org/10.1053/j.jvca.2020.02.039.
https://doi.org/10.1053/j.jvca.2020.02.0... 39. Wu F, Song Y, Zeng HY, Ye F, Rong WQ, Wang LM, et al. [Discussion on diagnosis and treatment of hepatobiliary malignancies during the outbreak of novel coronavirus pneumonia]. Zhonghua Zhong Liu Za Zhi. 2020;42(0):E004. https://doi.org/10.3760/cma.j.cn112152-20200227-00137
https://doi.org/10.3760/cma.j.cn112152-2... ). Nonetheless, incidents during the exit of the trocar were reported, in which leakage of gas occurred in many cases, suggesting that laparotomy with extensive fluid drainage would be safer (²⁶26. Di Saverio S, Pata F, Gallo G, Carrano F, Scorza A, Sileri P, et al. Coronavirus pandemic and Colorectal surgery: practical advice based on the Italian experience. Color Dis. 2020. https://doi.org/10.1111/codi.15056
https://doi.org/10.1111/codi.15056... ). Most hospitals agree that isolating the operating area is a better approach; however, this is difficult to accomplish. Operating inside closed doors can help reduce the number of infections among surgical staff members (¹⁵15. Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP, et al. [Recommendations for general surgery clinical practice in 2019 coronavirus disease situation]. Zhonghua Wai Ke Za Zhi. 2020;58(3):170-7. https://doi.org/10.3760/cma.j.issn.0529-5815.2020.03.003.
https://doi.org/10.3760/cma.j.issn.0529-... ).

An article also suggested that SARS-CoV-2 could penetrate traditional surgical masks and gowns, thus necessitating the use of N95 masks and level 3 protection suits (²³23. Zou J, Yu H, Song D, Niu J, Yang H. Advice on Standardized Diagnosis and Treatment for Spinal Diseases during the Coronavirus Disease 2019 Pandemic. Asian Spine J. 2020;14(2):258-63. https://doi.org/10.31616/asj.2020.0122.
https://doi.org/10.31616/asj.2020.0122... 24. Chen YH, Peng JS. [Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(2):I-IV. https://doi.org/10.3760/cma.j.issn.1671-0274.2020.02.001
https://doi.org/10.3760/cma.j.issn.1671-... 25. Chang Liang Z, Wang W, Murphy D, Po Hui JH. Novel Coronavirus and Orthopaedic Surgery: Early Experiences from Singapore. J Bone Joint Surg Am. 2020. https://doi.org/10.2106/JBJS.20.00236
https://doi.org/10.2106/JBJS.20.00236... ). Another significant concern is the procedure time, as greater exposure in the operating room leads to a higher risk of infection. Therefore, an article suggested that a team comprising the minimum number of experienced professionals should perform the surgery to optimize the procedure and reduce the surgery time (¹¹11. Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. 2020. https://doi.org/10.1001/jamaoto.2020.0764
https://doi.org/10.1001/jamaoto.2020.076... ). Another recommended approach for enhancing safety is selecting only known and reliable methods to reduce the risk of postoperative complications and prolonged hospitalization.

Trainee involvement must be reevaluated, as it can lead to an increase in procedure time and, consequently, the risk of exposure (¹²12. Soetikno R, Teoh AY, Kaltenbach T, Lau JY, Asokkumar R, Cabral-Prodigalidad P, et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc. 2020. pii: S0016-5107(20)34033-5. https://doi.org/10.1016/j.gie.2020.03.3758.
https://doi.org/10.1016/j.gie.2020.03.37... 13. Simonato A, Giannarini G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, et al. Pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol. 2020. https://doi.org/10.23736/S0393-2249.20.03861-8
https://doi.org/10.23736/S0393-2249.20.0... 14. Ross SW, Lauer CW, Miles WS, Green JM, Christmas AB, May AK, et al. Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19). J Am Coll Surg. 2020. pii: S1072-7515(20)30263-5. https://doi.org/10.1016/j.jamcollsurg.2020.03.019.
https://doi.org/10.1016/j.jamcollsurg.20... ). The involvement of medical students in the clerkship and subinternship periods in teaching hospitals also leads to a similar problem as trainee involvement. The use of electrocautery is controversial because it produces a high concentration of contaminated gases (²⁰20. Correia MITD, Ramos RF, Bahten LCV. The surgeons and the COVID-19 pandemic. Rev Col Bras Cir. 2020;47:e20202536. https://doi.org/10.1590/0100-6991e-20202536
https://doi.org/10.1590/0100-6991e-20202... ). Therefore, an article suggested avoiding its use in a pandemic setting (²⁸28. Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, et al. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg. 2020. https://doi.org/10.1001/jamaoto.2020.0780.
https://doi.org/10.1001/jamaoto.2020.078... 29. Hu XH, Niu WB, Zhang JF, Li BK, Yu B, Zhang ZY, et al. [Treatment strategies for colorectal cancer patients in tumor hospitals under the background of corona virus disease 2019]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(3):201-8. 30. Polites SF, Azarow KS. Perspectives on Pediatric Appendicitis and Appendectomy During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. J Laparoendosc Adv Surg Tech A. 2020;30(4):356-7. https://doi.org/10.1089/lap.2020.0197.
https://doi.org/10.1089/lap.2020.0197... 31. Chew MH, Koh FH, Ng KH. A call to arms: a perspective of safe general surgery in Singapore during the COVID-19 pandemic. Singapore Med J. 2020. https://doi.org/10.11622/smedj.2020049
https://doi.org/10.11622/smedj.2020049... 32. Si Y, Sun XF, Zhong M, Yue JN, Fu WG. [Countermeasures and treatment for aortic acute syndrome with 2019 coronavirus disease]. Zhonghua Wai Ke Za Zhi. 2020;58(3):178-82. https://doi.org/10.3760/cma.j.issn.0529-5815.2020.03.004.
https://doi.org/10.3760/cma.j.issn.0529-... 33. Alto risco de infecção por COVID-19 para cirurgiões de cabeça e pescoço - SBCCP - Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP). Available from: http://sbccp.org.br/alto-risco-de-infeccao-por-covid-19-para-cirurgioes-de-cabeca-e-pescoco/ [cited Apr 11th, 2020]
http://sbccp.org.br/alto-risco-de-infecc... 34. Yang Y, Soh HY, Cai ZG, Peng X, Zhang Y, Guo CB. Experience of Diagnosing and Managing Patients in Oral Maxillofacial Surgery during the Prevention and Control Period of the New Coronavirus Pneumonia. Chin J Dent Res. 2020;23(1):57-62. https://doi.org/10.3290/j.cjdr.a44339.
https://doi.org/10.3290/j.cjdr.a44339... 35. Zhao L, Zhang L, Liu JW, Yang ZF, Shen WZ, Li XR. [The treatment proposal for the patients with breast diseases in the central epidemic area of 2019 coronavirus disease]. Zhonghua Wai Ke Za Zhi. 2020;58(0):E005. https://doi.org/10.3760/cma.j.cn112139-20200221-00116
https://doi.org/10.3760/cma.j.cn112139-2... ). Another article suggested allowing the use of electrocautery with some modifications, such as adjusting to the lowest possible effective power and employing a smoke absorption device (¹⁵15. Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP, et al. [Recommendations for general surgery clinical practice in 2019 coronavirus disease situation]. Zhonghua Wai Ke Za Zhi. 2020;58(3):170-7. https://doi.org/10.3760/cma.j.issn.0529-5815.2020.03.003.
https://doi.org/10.3760/cma.j.issn.0529-... 16. Luo Y, Zhong M. [Standardized diagnosis and treatment of colorectal cancer during the outbreak of corona virus disease 2019 in Renji hospital]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(3):211-6. https://doi.org/10.3760/cma.j.cn441530-20200217-00057.
https://doi.org/10.3760/cma.j.cn441530-2... 17. Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol. 2020. https://doi.org/10.4097/kja.20116
https://doi.org/10.4097/kja.20116... 18. Li Y, Qin JJ, Wang Z, Yu Y, Wen YY, Chen XK, et al. [Surgical treatment for esophageal cancer during the outbreak of COVID-19]. Zhonghua Zhong Liu Za Zhi. 2020;42(0):E003. 19. Lui RN, Wong SH, Sánchez-Luna SA, Pellino G, Bollipo S, Wong MY, et al. Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol. 2020. https://doi.org/10.1111/jgh.15053
https://doi.org/10.1111/jgh.15053... ).

Our review also found that it is relevant to strengthen the knowledge of health-care workers about hygiene measures during their shift. The constant stress caused by imminent contamination is known to make professionals more likely to experience mental health issues (²⁰20. Correia MITD, Ramos RF, Bahten LCV. The surgeons and the COVID-19 pandemic. Rev Col Bras Cir. 2020;47:e20202536. https://doi.org/10.1590/0100-6991e-20202536
https://doi.org/10.1590/0100-6991e-20202... 21. Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd R, Sajjadi H, et al. Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery. 2020. pii: nyaa125. https://doi.org/10.1093/neuros/nyaa125
https://doi.org/10.1093/neuros/nyaa125... 22. Zheng MH, Boni L, Fingerhut A. Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000003924
https://doi.org/10.1097/SLA.000000000000... ). Therefore, we advise hospitals to offer psychological support to their staff.

Most centers advise doctors to postpone elective surgeries for two main reasons: the risk of contamination is too high in the current epidemiological situation and medical equipment should be reserved for managing COVID-19 emergency cases (²⁶26. Di Saverio S, Pata F, Gallo G, Carrano F, Scorza A, Sileri P, et al. Coronavirus pandemic and Colorectal surgery: practical advice based on the Italian experience. Color Dis. 2020. https://doi.org/10.1111/codi.15056
https://doi.org/10.1111/codi.15056... ). Online consultations are strongly recommended instead of hospital or clinic visits (²⁷27. Ficarra V, Novara G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, et al. Urology practice during COVID-19 pandemic. Minerva Urol Nefrol. 2020. https://doi.org/10.23736/S0393-2249.20.03846-1
https://doi.org/10.23736/S0393-2249.20.0... ).

CONCLUSION

Our main conclusion from this review is that any elective surgery that can be delayed should be postponed, taking into consideration that it may take 2-3 months for the health-care situation to return to normal. We also conclude that all surgical patients should be screened for COVID-19, with preference given to PCR tests. Regarding surgical practice recommendations, we believe that surgical staff should be reduced to the minimum, without compromising the procedure and any operation should be performed by the most experienced surgeon, so that the procedure time is reduced. An institutional workflow to assist medical staff in decision making and in dealing with mental health issues should also be established.

REFERENCES

Publication Dates

History