Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices

Abstract

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.

Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100).

Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries.

Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions.

Study registration: Registered in ClinicalTrials.gov: NCT04344197.

Figure 1

Country’s risk category and number of centers. Countries were classified into high (>5000), intermediate (100-5000) and low (<100) risk groups based on the number of cumulative deaths reported by the WHO on April 8, 2020. Other countries in intermediate risk (n = 130): Mexico (24), Portugal (17), Romania (13), Austria (12), Germany, India, Ireland (10), Belgium (8), Brazil, Switzerland (5), Canada, Sweden (4), South Korea (3), Indonesia (2), Denmark, Iran, and Poland (1). Other countries in low risk (n = 115): Ukraina (11), Azerbaijan (9), Pakistan (8), Egypt, Israel (6), Greece, Lithuania, Norway (5), Belarus, Colombia, Lebanon (4), Australia, Czech Republic, Sri Lanka (3), Argentina, Armenia, Bulgaria, Finland, Latvia, Moldova, Puerto Rico, South Africa, Thailand (2), Afghanistan, Hungary, Iceland, Iraq, Israel, Korea, Kyrgyzstan, Morocco, Nepal, New Zealand, North Macedonia, Oman, Palestine, Panama, Perú, Philippines, Saudi Arabia, Serbia, Singapore, Tunisia, United Arab Emirates (1).