Restarting Elective Surgeries during COVID-19 Pandemic: Innovations and Anaesthesiologist’s Perspective

Abstract

Introduction: Lockdown imposed due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) caused by coronavirus led to disruption of all aspects of life across the world with serious consequences in delivering of routine surgical services to the patients. Anaesthesiologists and surgeons in the study Institute devised clinical assessment based protocols for preanaesthesia assessment {not including routine preoperative Coronavirus Disease 2019 (COVID-19) Testing} to ensure timely conduct of elective surgeries as soon as patients started reporting to hospital. Aim: To evaluate the efficacy of various measures taken by anaesthesiologists and operation theatre team to impart surgical care during COVID-19 pandemic without increasing the risk of transmission of COVID-19 disease. Materials and Methods: A retrospective observational study was carried out with the idea of comparing the surgical workload of year 2020 (January to December 2020) with the previous year 2019 (January to December 2019). The study was conducted in the month of March 2021, in a 627-bedded secondary care multispeciality hospital in northern India. The data on total number of patients undergoing surgeries in year 2020 was compared with that of year 2019 on the basis of elective surgeries, emergency surgeries and different modalities of anaesthesia used to conduct all those surgeries. These variables from both the years were compared using chi-square tests and Statistical Package for Social Sciences (SPSS) trial version 23.0. Results: The total numbers of surgeries had reduced in year 2020 (3923 in 2019 vs 2500 in 2020) with highest reduction in the months of April and May 2020 (83.08 and 74.75%, respectively). However, with implementation of clinical assessment based protocols and targeted changes in anaesthesia practice, the decrease in elective surgeries came to statistically non significant levels by the month of September 2020. The difference in percentage of cases carried out under regional anaesthesia (4.23% in 2019 vs 3.24% in 2020) was statistically not significant (p-value=0.051). The emergency surgeries in 2019 were 805 vs 742 in 2020, percentage change from 2019 base data was -7.83. The incidence of COVID-19 infection during postoperative period was nil in the Institute. The incidence of COVID-19 infection among the staff was found to be similar to the patients reported to the hospital despite of handling elective surgical cases. Conclusion: Regular surgical care can be safely provided after thorough clinical assessment of the patients in this ongoing pandemic. This did not lead to increase in incidence of COVID19 infection in healthcare workers as shown in our data. Hence, preoperative COVID-19 testing should be performed only when indicated by clinical history and examination. However, more studies with multiple centres are required to validate these protocols and hence facilitate the formation of even more refined ones.

Keywords

• coronavirus disease 2019
• lockdown
• protocols
• severe acute respiratory syndrome coronavirus-2