Safe Surgery During the COVID-19 Pandemic

PURPOSE OF REVIEW

Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future.

RECENT FINDINGS

Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

Telemedicine versus on-site treatment at a surgical university clinic: Study of 225 consecutive patients

INTRODUCTION

Recently, telemedical services are increasingly used. It remains unclear, if outpatients in general surgery can be treated via telemedicine (e.g. telework). We aimed to evaluate, if diagnosis and therapies of outpatients in general surgery can be found using a mobile healthcare communication app instead of personal contact.

MATERIAL AND METHODS

In a prospective, double blind, anonymized clinical study we included consecutive outpatients at a general surgery department at a university hospital. For the telemedical "treatment" the on-site doctors uploaded variables (e.g. anamnesis, radiograph, etc.) for each patient. The telemedical doctor received the information only via app and did not see the patient physically. Both, the doctor on-site and the virtual telemedical-doctor then uploaded the diagnosis and their suggested therapy - blinded to each other. The outpatient received the on-site treatment only. The virtual treatment was solely for scientific purposes and had no therapeutic impact.

RESULTS

225 consecutive surgical outpatients (53 % female and 47 % male) were included. Mean age was 61 years. In 84 % of cases the telemedical diagnosis matched the on-site diagnosis. The telemedical treatment was not inferior as compared to the on-site treatment in 94 % of all cases and the same therapy was proposed in 76 %. In 6% of all cases the telemedical therapeutic regimen could possibly harm or lead to an over- or under treatment of the patient.

CONCLUSION

Telemedical consultation seems to work in the field of general surgery. Telemedicine in general surgery potentially could decrease waiting time for an appointment and patient frequency. However, the potential harm of a wrong therapy remains due to the lack of a clinical observation.

EMERGING ONLINE TOOLS AND PLATFORMS FOR SCHOLARLY ACTIVITIES

Scholarly activities are increasingly dependent on a wide variety of online tools and platforms. Processing health information on such platforms may enrich research studies and solve some healthcare issues. Health information analyses and online surveys are frequently conducted to test old hypothesis and generate new ones. These studies require thorough understanding of the subject and skilful use of online platforms, including social media. Social media platforms are increasingly employed for retrieving and disseminating research data. Scholarly activities on Twitter and other globally popular social media are now recommended for research, education, and clinical practice. Aggregated social media information and related altmetric data have emerged as reflections of the immediacy effects of online sharing and commenting and as tools to complement citation analyses. Researchers and research managers may use altmetrics to plan their studies and introduce changes to the education process. Securing uninterrupted access to Internet and available online tools may facilitate quality research and other scholarly activities.