Should you opt for surgeries during COVID 19 pandemic or not? A surgeon weighs in

Updated on Jul 15, 2020 05:28 PM IST  |  884.8K
   
Should you opt for surgeries during COVID 19 pandemic or not? A surgeon weighs in
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The world has undergone a significant transformation in the last 5 to 6 months due to the COVID-19 pandemic. The changes, our society has gone through are apocalyptic. With a significant rise in COVID-19 patients, there was an immediate need for the allocation of valuable resources towards managing them. This had resulted in the cancellation of elective surgeries all over the world. There was a need to safeguard healthcare workers and the patients, which prompted surgical teams to develop their own protocols to tide over the situation.

Our society needed to work towards accepting this “new normal” and show a significant adherence to the same. Healthcare workers, frontline warriors have continued to work towards this phase with necessary changes that are required to make this safe. As the lockdown is being gradually lifted, routine as well as emergency surgical services are available as before. However,  in the interest of patient care and safety as well as the safety of doctors, nurses and healthcare workers certain changes in the healthcare pattern need to be implemented.

Surgeries can be broadly classified as 1- Elective or planned surgeries 2- Emergency or urgent surgeries.

Elective Surgeries:
These surgeries are non-emergent and are planned in advance after thoroughly investigating the patient. These may include, cancer surgeries, cosmetic surgeries, elective cesarean sections, tubal ligations, non-traumatic spine surgeries, joint replacements, hemorrhoids, fissures, kidney stones removal, gall bladder stones surgery, tonsillectomies, & minor procedures,

A commonly asked question is why elective (non-emergency) surgeries are being delayed? The disease was a new entity. Detailed knowledge was unavailable. The most basic principle of medicine, "primum non nocere", had to be adhered to. So till there was some clarity on the disease and its implications all non-emergency procedures were postponed.

In the initial phase, there were a lot of fears of ICUs falling woefully short for COVID-19 patients and therefore no major procedures that required postoperative ICU care were done. Since this disease involved the upper respiratory tract most anesthetists were wary of conducting these cases. Reports from other countries where COVID-19 was rampant reported maximal deaths in surgeons. Most of these surgeons were dentists, ENT specialists and orthopedic surgeons. This finding made surgeons wary.

A reputed medical journal reported a high concentration of the virus in abdominal fluid and this alerted general surgeons to the danger of inadvertent exposure to the virus. There was a fear amongst hospital administrators that their hospital would be sealed for a couple of weeks if a COVID-19 case was detected. To circumvent financial losses and administrative headaches, curtailing work was considered a better alternative.

These surgeries require PPE which was in short supply and desperately needed by healthcare workers for COVID-19 patients. Patients and caregivers might have undiagnosed COVID-19 or may be asymptomatic carriers. The highly contagious nature of the virus would put all involved theatre personnel at risk of contracting the disease to transmit the virus to all the healthcare workers. This transmission could happen before, during, or in the post-surgical period. In the postoperative period, the virus may also compromise the general recovery of the operated patient.

Prior to these surgeries, adequate precautions are being taken, by the healthcare workers, to avoid, the intermingling of COVID-19, & non-COVID-19 patients, in a hospital setup. Improve education understanding of the disease, better levels of preparedness, more effective treatment protocols have encouraged many hospitals in Mumbai, to cautiously resume routine surgical work. Swab test (RT-PCR) & HRCT-chest scans are being done, pre-operatively, subjective to which, the patient is being scheduled for elective surgeries.

Emergency surgeries:
Life-threatening surgical conditions require urgent surgical attention including emergency operative procedures. These include trauma, labor-delivery, perforated bowel, gangrene, intestinal obstruction, etc. These surgeries have been done all across the world, with necessary precautions in place. With any emergency surgery, one must weigh the risk of delay with the benefit that can be achieved by moving forward with the surgery.

With the expertise for patient care, infection prevention-control protocols, hospitals & healthcare workers are working hard to assess the urgency and need for surgery. It is best for a surgeon to decide the time of surgery based on its urgency, age & associated co-morbidities of the patients. The decision for surgery should be based upon a surgeon’s clinical judgment and assessment. Implementation of evidence-based medicine becomes important.

Aerosol generated during procedures such as intubation, electro-cautery use, and carbon dioxide insufflation in laparoscopy, which increases the risk to the healthcare workers. At present all patients requiring emergency surgery are tested for COVID-19. If possible surgery is withheld until the test report is available. When surgery cannot be delayed, the patient is considered to be suffering from COVID-19 and treated likewise. With the case count rising, the healthcare workers need to adopt the best care practices suited to the local scenario.

To conclude, both elective and emergency surgeries expose patients and healthcare workers to the risk of contracting COVID-19. As the understanding of the disease improves and guidelines get refined, treatment can be administered without delays and also decreased risks to both patients and healthcare workers. In this situation, prompt and correct diagnosis is vital for a good outcome.

By Dr. Gaurav Mishra, Consultant General & Laparoscopic Surgeon with leading Hospitals like Raheja Fortis, Hinduja Healthcare, Somaiya Superspeciality, Ashirwad Critical Care Unit and Ex- Assistant Professor - LTMGH- LTMMC. 

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