Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Abstract

Background: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.

Methods: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020).

Results: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.

Conclusion: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.

Keywords: COVID-19; Elective surgery; Emergency surgery; Laparoscopic surgery; Survey.

Fig. 1

a Type of Hospital (Teaching hospital/Non-teaching hospital); b Type of Hospital (Hub hospital/Spoke Hospital); c Type of Hospital (Public hospital/Private hospital/Contract clinic); d Beds of the surgical department

Fig. 2

a Type of Hospital during the COVID-19 pandemic; b Effective beds dedicated to surgical activity during the COVID-19 pandemic

Fig. 3

a Elective surgical procedure during the COVID-19 pandemic; b Emergency surgical procedures during the COVID-19 pandemic

Fig. 4

a Elective Minimally invasive surgery during the COVID-19 pandemic; b Emergency Minimally invasive surgery during the COVID-19 pandemic

Fig. 5

a Surgical staff referred to other departments dedicated to COVID-19 non-surgical patients; b Surgical staff tested positive for COVID-19

Fig. 6

a COVID-19-positive patients operated in the elective setting; b COVID-19-positive patients operated in emergency setting

Fig. 7

a COVID-19 screening policies for elective surgical admissions; b COVID-19 screening policies for emergency surgical admissions

Fig. 8

a Use of personal protective equipment—COVID-19-negative patients; b Use of personal protective equipment—COVID-19-positive patients; c Use of personal protective equipment—COVID-19 untested patients in emergency

Fig. 9

a Use of surgical smoke evacuation devices during laparoscopy; b Reduction in the use of high-energy devices