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      Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1 (Review Article)

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          Abstract

          The Coronavirus (COVID-19) pandemic has resulted in over 2.3 million confirmed cases and over 160,000 deaths. The impact of COVID-19 on surgical practice is widespread ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice.

          This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic.

          Highlights

          • •

            COVID-19 has a wide-ranging impact on surgical practice including changes to case prioritization, changes in operative technique and workforce planning.

          • •

            Telemedicine virtual clinics are to be encouraged where possible.

          • •

            Elective and non-urgent surgeries must be postponed.

          • •

            Consider safe non-surgical management of patients.

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          Most cited references51

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Na Zhu, Dingyu Zhang, Wenling Wang … (2020)
            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
              Article 0 comments Cited 11158 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ahmed Al-Jabir
                Journal
                Journal ID (nlm-ta): Int J Surg
                Journal ID (iso-abbrev): Int J Surg
                Title: International Journal of Surgery (London, England)
                Publisher: IJS Publishing Group Ltd. Published by Elsevier Ltd.
                ISSN (Print): 1743-9191
                ISSN (Electronic): 1743-9159
                Publication date PMC-release: 12 May 2020
                Publication date (Electronic): 12 May 2020
                Affiliations
                [a ]GKT School of Medical Education, King’s College London, United Kingdom
                [b ]Imperial College Healthcare NHS Trust, London, United Kingdom
                [c ]UCL Medical School, University College London, United Kingdom
                [d ]Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
                [e ]Stanford University, Palo Alto, United States
                [f ]Barts Health NHS Trust, London, United Kingdom
                Author notes
                [∗ ]Corresponding author. , GKT School of Medical Education, Guy’s Campus, King’s College London, London, SE1 1UL ahmed@ 123456ijspg.com
                Article
                Publisher ID: S1743-9191(20)30405-2
                DOI: 10.1016/j.ijsu.2020.05.022
                PMC ID: 7214340
                PubMed ID: 32407799
                SO-VID: 3960a677-4534-4497-a214-9db2a55d45a5
                Copyright © © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 19 April 2020
                Date revision received : 6 May 2020
                Date accepted : 9 May 2020
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                Subject: Article

                ScienceOpen disciplines: Surgery
                Keywords: novel coronavirus,covid-19,surgery
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: novel coronavirus, covid-19, surgery

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