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Safe surgery during the coronavirus disease 2019 crisis
David R Tivey1,2, Sean S Davis2, Joshua G Kovoor3
1Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
Background:
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a global pandemic. Surgical care has been impacted, with concerns raised around surgical safety, especially in terms of laparoscopic versus open surgery. Due to potential aerosol transmission of SARS-CoV-2, precautions during aerosol-generating procedures and production of surgical plume are paramount for the safety of surgical teams.
Methods:
A rapid review methodology was used with evidence sourced from PubMed, Departments of Health, surgical colleges and other health authorities. From this, a working group of expert surgeons developed recommendations for surgical safety in the current environment.
Results:
Pre-operative testing of surgical patients with reverse transcription-polymerase chain reaction does not guarantee lack of infectivity due to a demonstrated false-negative rate of up to 30%. All bodily tissues and fluids should therefore be treated as a potential source of COVID-19 infection during operative management. Caution must be taken, especially when using an energy source that produces surgical plumes, and an appropriate capture device should also be used. Limiting the use of such devices or using lower energy devices is desirable. To reduce perceived risks association with desufflation of pneumoperitoneum during laparoscopic surgery, an appropriate suction irrigator system, attached to a high-efficiency particulate air filter, should be used. Additionally, appropriate use of personal protective equipment by the surgical team is necessary during high-risk aerosol-generating procedures.
Conclusions:
As a result of the rapid review, evidence-based guidance has been produced to support safe surgical practice.
Insights
Surgical teams must implement strict safety measures during the COVID-19 pandemic, treating all patients as potentially infectious. Enhanced precautions are crucial for aerosol-generating procedures to protect staff from SARS-CoV-2 transmission.
Area of Science:
- Medicine
- Infectious Diseases
- Surgical Safety
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, significantly impacts surgical care and patient safety.
- Concerns exist regarding aerosol transmission of SARS-CoV-2 during surgical procedures, particularly laparoscopic versus open surgery.
- Surgical plume and aerosol-generating procedures necessitate stringent precautions for healthcare worker safety.
Purpose of the Study:
- To develop evidence-based recommendations for safe surgical practices during the COVID-19 pandemic.
- To address concerns related to aerosol transmission and surgical plume during operative management.
- To provide guidance on protecting surgical teams from SARS-CoV-2 infection.
Main Methods:
- A rapid review methodology was employed, sourcing evidence from medical databases and health authorities.
- Expert surgeons formed a working group to synthesize findings and develop safety recommendations.
- Recommendations focused on pre-operative testing, patient fluid handling, and aerosol management.
Main Results:
- Pre-operative reverse transcription-polymerase chain reaction (RT-PCR) testing has a false-negative rate up to 30%, necessitating universal precautions.
- All bodily tissues and fluids should be considered infectious; caution is advised with energy devices producing surgical plumes.
- Use of high-efficiency particulate air (HEPA) filtered suction/irrigator systems for pneumoperitoneum desufflation and appropriate personal protective equipment (PPE) are recommended for high-risk procedures.
Conclusions:
- Evidence-based guidance has been developed to support safe surgical practice amidst the COVID-19 pandemic.
- Adherence to recommended safety protocols is essential for protecting surgical teams and patients.
- The findings underscore the importance of a proactive approach to infection control in surgical settings.
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