Surgery during Covid pandemic: It is important to keep in mind that the decision to perform or not a surgical procedure should be based on several considerations, including clinical and social factors.
COVID-19 has emerged as a public health crisis that has deeply impacted how medical and surgical care is delivered. Countries around the globe, including India, had a variable initial response to the COVID-19 pandemic which included imposing massive lockdowns and quarantine. Patients with COVID-19 and emergency cases were prioritized.
The unpredictability of the timeline of COVID-19 led to patients lacking access to medical and surgical care, for several months. The potential clinical outcomes due to the delay in elective surgical procedures have a more detrimental impact on patients’ health compared to that of COVID-19. All specialties of surgical practice have been significantly impacted and have made guidelines to manage the crisis. Non-surgical management is being considered and all specialties have had to manage urgent surgical procedures. Surgeons should be able to continue to provide safe and effective care to their patients during the COVID-19 pandemic as guidelines specific to each specialty are being enforced and adhered to.
Cutting back on elective surgical procedures and prioritizing non-delayed oncologic or emergency surgeries are a few of the significant changes. While some cases can be postponed for some weeks without a relevant impact on the patient’s general conditions and outcomes, such as abdominal wall surgery and bariatric surgery, the same standards cannot be applied to other types of surgical procedures. Though this changed strategy is needed, considerations are needed as the vast majority of these deferrable surgical procedures are associated with progressive diseases, so that delays may turn elective surgery into an emergency. It is important to keep in mind that the decision to perform or not a surgical procedure should be based on several considerations, including clinical and social factors.
Prioritization of surgical services during this pandemic must be a careful balance of patient needs and resource availability:
1. What will be the impact of the delay on primary surgical outcomes
2. Feasibility of alternative procedures that have less requirement for an OR
3. If there are any co-morbidities and or any increased risk of complications
4. The threat to patient life if the procedure is not performed immediately
5. The threat of permanent organ dysfunction if the procedure is not performed
6. The risk of rapidly progressing severe symptoms and disease progression if the procedure is not performed Surgical Training and sailboarding
As the medical fraternity is engaged in combating the pandemic, and the surgical procedures are prioritized, the skill-building of surgical residents needs to be reconsidered. Adopting technology in medicine has definitely simplified disease management and has helped deliver superior patient outcomes, thereby giving more importance to skill development.
Guidelines and clinical governance protocols accepted by the medical fraternity are essential for training. Institutional protocols, competency of the OR and surgical team, and the types of patients treated in the hospital are also important. Another factor is the individual, e.g. the surgeon`s attitude, the ability for developing new skills, and experience.
All this makes continuous skill development, capability building, and training of the relevant staff important. Training of the surgeon is most important: Several learning methodologies, the use of box-trainers and practicing in animal laboratories for training in laparoscopic surgery techniques facilitate the process of learning and skill development. Surgical telementoring plays a pivotal role in bridging gaps of knowledge, geographical location, accessibility, and quality thus enabling mentorship in advanced procedures and newer technologies. Surgical telementoring can help accelerate the learning curve.
Web‐based solutions are being increasingly helpful in supporting clinical and academic activities during the COVID‐19 pandemic. To summarize, surgical skills training is undergoing a paradigm shift. Advancing technology has led to the availability of newer medical devices and equipment. Skill development and adequate training of a surgeon is necessary to achieve optimal patient outcomes and ensure the safe usage of these devices by HCPs.
(Disclaimer: All Information provided in the article are independent views expressed by Dr Anish Desai, founder of IntelliMed Healthcare Solutions. Desai has been a reputable member of the American College of Clinical Pharmacology(US), Royal Society of Medicine(London), Society of Pharmaceutical Medicine(UK), Clinical Research Professionals(US).)