Surgical Practice in the Current COVID-19 Pandemic: A Rapid Systematic Review

Abstract

The coronavirus disease (COVID-19) outbreak </mac_aq>started in Wuhan, China, in December 2019, and evolved into a global problem in a short period. The pandemic has led to many social and health-care challenges. In this context, surgery is an area that is facing the need for many adaptations. In this systematic literature review, we analyzed different perspectives concerning this situation, aiming to provide recommendations that could guide surgeons and </mac_aq>entities toward screening, elective and emergency surgeries, decision making, and operating room management. A computerized search in PubMed, Scopus, and Scientific Electronic Library Online (SciELO) for relevant literature up to April 4, 2020, was performed. Articles were included if they were related to surgery dynamics in the context of the COVID-19 pandemic. 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. Concerning preoperative testing </mac_aq>for severe acute respiratory syndrome coronavirus 2 infection, 29 (74.4%) articles recommended some kind of </mac_aq>screening. Another major suggestion was postponing all (or at least selected) elective operations (29 articles, </mac_aq>74.4%). Several additional recommendations with respect to surgical practice or surgical staff were also assessed and discussed, such as performing laparoscopic surgeries and avoiding the use of electrocauterization. On the basis of the current literature, we concluded that any surgery that can be delayed should be postponed. COVID-19 screening is strongly recommended for all surgical cases. Moreover, surgical staff should be reduced to the essential members and provided with institutional psychological support.

Figure 1

Selection diagram.

Figure 2

Distribution of articles according to type. The “Other” category included reviews, correspondences, and case reports.

Figure 3

Distribution of articles according to the reported surgery type. Head and neck surgeries included otorhinolaryngology surgeries. Gastrointestinal surgeries included endoscopies.

Figure 4

Distribution of articles according to recommendation for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening. A total of 29 articles suggested some kind of screening, ranging from clinical evaluation to nasal swab testing, whereas 10 articles did not offer guidance. None of the articles negated the need for screening.

Figure 5

Distribution of 29 articles according to specific recommendations for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening. “PCR symptomatic patients” (n=1) refers to the recommendation of testing only surgical patients with coronavirus disease symptoms. “PCR staff and patients” (n=1) refers to the recommendation of testing all surgical patients and surgical staff. “No PCR” (n=3) refers to the recommendation of using other methods of screening based on computed tomography scan, clinical examination, body temperature measurement, and blood tests. “PCR all patients” (n=24) refers to the recommendation of testing all surgical patients through nasal swab testing or other kinds of PCR testing. PCR: polymerase chain reaction

Figure 6

Distribution of articles according to recommendations related to delaying or continuing elective surgeries. “Evaluate epidemic level” refers to the recommendation of postponing elective surgeries according to epidemic stages. All articles recommended taking precautions about infections in the surgical environment.