Gupta Rama, Mohan Bishav, Garg Kamakshi, Taneja Ashima, Virk Satpal S, Grewal Anju, Mahajan Rajesh
Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Anaesthesiol Clin Pharmacol. 2020 Jul-Sep;36(3):325-330. doi: 10.4103/joacp.JOACP_420_20. Epub 2020 Sep 15.
COVID-19 disease has imposed challenges in caring for non-Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID-19 pandemic so as to provide a road-map for safer approach.
We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5-week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS- CoV-2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID-19 by quantitative RT-PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID-19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level-3 protection without delay. The clinical data was reviewed and analysed.
A total of 764 surgical procedures were conducted, of which 70.7% were elective essential surgeries, with 95.4% of these patients being discharged in stable healthy condition. Approximately 23% of the elective and 26% of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04%, but the overall mortality rate was approximately 2.5%. Only two patients (0.3%) tested positive for COVID-19 in our series.
A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.
新型冠状病毒肺炎（COVID-19）疫情给非新冠择期手术患者的护理带来了挑战。随着择期手术变得至关重要，我们建议评估在COVID-19大流行初期所实施手术的方法及结果，以便为更安全的手术方式提供路线图。
我们回顾性评估了2020年4月18日至2020年5月28日这5周期间接受必要择期和急诊手术患者的结局。所有患者在入院时均在前台接受筛查，以确定是否可能接触严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。对需要住院的患者进行鼻咽拭子定量逆转录聚合酶链反应（RT-PCR）检测，以筛查COVID-19。需要进行必要择期手术的患者，若COVID-19检测呈阴性，则安排手术。急诊手术在划定的COVID-19手术室进行，立即采取三级防护措施。对临床数据进行回顾和分析。
共进行了764例手术，其中70.7%为必要择期手术，这些患者中有95.4%出院时病情稳定健康。约23%的择期手术和26%的急诊手术属于手术难度III级，其中大多数在全身麻醉下进行。术后死亡率为1.04%，但总体死亡率约为2.5%。在我们的系列病例中，只有两名患者（0.3%）COVID-19检测呈阳性。
强有力的术前筛查和检测能够实现必要择期手术的安全安排。
