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. 2020 Oct;107(11):1450-1458.
doi: 10.1002/bjs.11747. Epub 2020 Jun 27.

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process

Welsh Surgical Research Initiative (WSRI) Collaborative  1
Collaborators, Affiliations

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process

Welsh Surgical Research Initiative (WSRI) Collaborative. Br J Surg. 2020 Oct.

Abstract
in English, Spanish

Background: Operating room (OR) practice during the COVID-19 pandemic is driven by basic principles, shared experience and nascent literature. This study aimed to identify the knowledge needs of the global OR workforce, and characterize supportive evidence to establish consensus.

Methods: A rapid, modified Delphi exercise was performed, open to all stakeholders, informed via an online international collaborative evaluation.

Results: The consensus exercise was completed by 339 individuals from 41 countries (64·3 per cent UK). Consensus was reached on 71 of 100 statements, predominantly standardization of OR pathways, OR staffing and preoperative screening or diagnosis. The highest levels of consensus were observed in statements relating to appropriate personal protective equipment (PPE) and risk distribution (96-99 per cent), clear consent processes (96 per cent), multidisciplinary decision-making and working (97 per cent). Statements yielding equivocal responses predominantly related to technical and procedure choices, including: decontamination (40-68 per cent), laminar flow systems (13-61 per cent), PPE reuse (58 per cent), risk stratification of patients (21-48 per cent), open versus laparoscopic surgery (63 per cent), preferential cholecystostomy in biliary disease (48 per cent), and definition of aerosol-generating procedures (19 per cent).

Conclusion: High levels of consensus existed for many statements within each domain, supporting much of the initial guidance issued by professional bodies. However, there were several contentious areas, which represent urgent targets for investigation to delineate safe COVID-19-related OR practice.

Antecedentes: La práctica en el quirófano (operating room, OR) durante la pandemia por la COVID- 19 se basa en principios básicos, experiencias compartidas y literatura reciente. Este estudio tuvo como objetivo identificar las necesidades de conocimiento global del personal de quirófano y caracterizar la evidencia existente para establecer un consenso. MÉTODOS: Se realizó un estudio basado en una metodología Delphi modificada y rápida, abierta a todos los interesados y a través de una evaluación colaborativa internacional online.

Resultados: El procedimiento de consenso fue completado por 339 personas de 41 países (64% Reino Unido). Se llegó a un consenso en 71/100 ítems, predominantemente en relación a la estandarización de los circuitos en OR, la dotación de personal y el cribaje preoperatorio o el diagnóstico. Los niveles más altos de consenso se observaron en los ítems relacionadas con el equipo personal y de protección (personal protective equipment, PPE) apropiado y la distribución de riesgos (96-99%), claridad en los procesos de consentimiento (96%), toma de decisiones multidisciplinarias y trabajo (97%). Los ítems que generaron respuestas equívocas estaban relacionadas principalmente con opciones técnicas y de procedimiento, incluyendo: descontaminación (40-68%), sistemas de flujo laminar (13-61%), reutilización de PPE (58%), estratificación de los pacientes por riesgo (21-48%), cirugía abierta versus laparoscópica (63%), colecistostomía preferente en patología biliar (48%) y definición de procedimientos generadores de aerosol (19%). CONCLUSIÓN: Existieron altos niveles de consenso para muchos ítems dentro de cada ámbito, apoyando gran parte de la orientación inicial emitida por los organismos profesionales. Sin embargo, surgieron varias áreas polémicas, que representan objetivos urgentes para la investigación para poder definir la práctica segura en OR relacionada con la COVID-19.

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Figures

Graphical Abstract
Graphical Abstract
Fig. 1
Fig. 1
World map choropleth of Delphi consensus exercise participation
See this image and copyright information in PMC

References

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    1. Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg 2020; 10.1097/sla.0000000000003924 [Epub ahead of print]. - DOI - PMC - PubMed
    1. Welsh Surgical Research Initiative (WSRI) Collaborative . Systematic review of recommended operating room practice during the COVID-19 pandemic. BJS Open 2020; 10.1002/bjs5.50304. - DOI - PMC - PubMed
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