key: cord-0817846-tkwcvwch
authors: Arolfo, Simone; Velluti, Francesco; Romagnoli, Renato; Lo Secco, Giacomo; Allaix, Marco Ettore; Morino, Mario
title: COVID‐19 outbreak and the practice of surgery: do we need to change?
date: 2020-06-22
journal: Br J Surg
DOI: 10.1002/bjs.11763
sha: 60f704bcd765675846e7c2c93dbefd42d33aa015
doc_id: 817846
cord_uid: tkwcvwch

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We report our clinical experience between the first day of lockdown (9 March) and 15 April. The results are compared to those obtained during the same period in 2019.

Starting 8 March, a national decree forced surgical units to limit their activity to emergency and cancer surgery [3] [4] . Patients who entered the Emergency Department followed two separate pathways, depending on the presence of any symptom related to COVID-19. All patients with indication for surgery were screened for COVID-19 preoperatively 5 . In addition, patients scheduled for elective surgery were tested prior to surgery. If negative, they underwent the planned surgery, otherwise the operation was postponed and rescheduled after resolution of COVID-19 infection. A smoke filtration system was used in all laparoscopic procedures. During postoperative course, patients who developed a cough, fever or respiratory symptoms were tested for COVID-19 and, if positive, transferred to a COVID-19 area. Clinical results and statistics are presented in Table 1 .

In the elective surgery group, two (1⋅5 per cent) patients were preoperatively diagnosed with COVID-19; after resolution both patients had surgery without complications.

Overall, one (of 373) (0⋅3 per cent) patient developed a COVID-19 infection during the postoperative course, successfully treated in a dedicated COVID-19 ward.

This analysis from a region badly hit by the COVID-19 outbreak brings four considerations. First, an increase in postoperative complication rate was not observed. Despite the fact the 2019 group included both major and minor surgical operations and patients in 2020 had a higher rate of medical comorbidities, short-term surgical outcomes were similar. Second, we recorded no increase in the anastomotic leak rate, thus challenging the recommendation that more patients undergoing gastrointestinal resection should be diverted. Third, we have not shifted towards an open approach. COVID-19 has never been identified in surgical smoke, and therefore surgeons should not switch to open surgery for unproven reasons. Fourth, only one patient during the post operative course and no one from the surgical team were infected by COVID-19, showing that adequate screening and pathways are able to guarantee patients' and operators' safety.

In conclusion, the need to modify surgical strategies during the COVID-19 outbreak is not confirmed by our experience. Nevertheless, larger series are needed to support such findings. 

Safe management of surgical smoke in the age of COVID-19

Is the use of laparoscopy in a COVID-19 epidemic free of risk?

Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2)

COVID-19 pandemic: perspectives on an unfolding crisis

COVID-19 and emergency surgery