Constantine Halkias on behalf of COVIDSurg
Surgery in a pandemic
Policies and public health efforts have not addressed the impact of pandemics on the provision of surgical services and the effects on health-related outcomes on surgical patients. This also applies to the response to Coronavirus disease 2019 (COVID-19). There hasn’t been any related research or analysis despite the impact of the pandemic so far. Understanding the effects of COVID-19 on patients undergoing surgery along with the effects of this pandemic on the provision of surgical services is a fundamental step to understanding the various different effects of a healthcare emergency of that magnitude and to implement policies from the lessons learned.
Impact on surgical patients
Undoubtedly despite the global focus to encounter the pandemic itself and the need to improve provision of services and treatments related to the immediate effects of COVID-19, with intensive care playing a major role, there are still millions of patients who will need surgical treatment. Major focus should be the provision of emergency surgical care, cancer surgery and transplant surgery. There is little or no knowledge on the outcomes of surgical patients with COVID-19 related disease.
Low quality data from a case series of patients who underwent cardiac surgery and acquired Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) did show very high mortality of 83.33% (1). This has major direct implications on the management of emergency surgical patients during the pandemic as well as on the ongoing provision of organ transplantation and cancer related operations. Whether major cancer surgery and organ transplantation should be delayed and for how long, in view of the possible worse outcomes during the pandemic is one of the issues that should be investigated.
Impact on surgical services
We also need to address the effects of the current pandemic on surgical services provision. It is an unprecedented situation that has already changed the way surgeons and health systems worldwide are offering surgical services. There is also very low quality evidence available from the 2003 Hong Kong Severe Acute Respiratory Syndrome (SARS) epidemic that showed significant reduction in the colorectal surgical caseload that had a major negative impact on waiting times and training (2). Although it’s certain that the impact of the current COVID-19 pandemic will be of unprecedented severity, it’s actual consequences and the implications on resources, staff allocation and training are still uncertain. Understanding the effect of the pandemic would also inform future global policy around cancer and transplantation surgery during pandemics, and the provision of surgical services in general.
A new project
There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery. To address the above issues we designed CovidSurg, an international group of surgeons and anaesthetists, with representation from Canada, China, Germany, Hong Kong, Italy, Korea, Singapore, Spain, United Kingdom, and the United States. Our aim is to capture real-world data and share international experience that will inform the management of this complex group of patients who undergo surgery throughout the COVID-19 pandemic, improving their clinical care and to understand the effects of the pandemic on the provision of surgical services.
- Outbreak of Middle East Respiratory Syndrome-Coronavirus Causes High Fatality After Cardiac Operations. Nazer RI, Ann Thorac Surg. 2017 Aug;104(2):e127-e129. doi: 10.1016/j.athoracsur.2017.02.072.
- Tales from the frontline: the colorectal battle against SARS. Bradford IM Colorectal Dis. 2004 Mar;6(2):121-3. doi: 10.1111/j.1462-8910.2004.00600.x