Standardized perioperative practice in surgery during the COVID-19 pandemic: a narrative review of the evidence.

INTRODUCTION

The Coronavirus (COVID-19) pandemic activated a global health crisis. The best practice in operating room (OR) is a discussed argument. This review was performed to clarify the importance and effectiveness of standardized clinical practice (procedure, organization, guidance), identifying contemporary evidence deduced from some international experience. We decided to make a narrative review that analyses the most current shared guidelines and procedures in management of COVID-19 patients in perioperative theatre.

EVIDENCE ACQUISITION

Medline was searched using PubMed (from 1 April 2020 to 22 December 2020) for relevant study according with Prisma Guidelines. The studies were assessed and classified for levels of evidence and recommendation. Three factors were extracted: OR organization, personnel safety and procedures.

EVIDENCE SYNTHESIS

44 articles were identified: eleven met eligibility criteria: of these, four articles are expert opinion/experience/descriptive study, one is a multicenter/descriptive study and six are review/systematic review. 33 articles were excluded because did not meet inclusion criteria. The studies selection is focused on clinical processes in the operating theatre, guidelines for the OR safety, correct procedures for personal protective equipment use, experience and recommendations related to COVID-19 context.

CONCLUSIONS

Despite the modest number of studies and high evidence, all the publications show agreement about many aspects of OR practice. Global experiences selection confirms the role and the importance of a standardized practice in operating theatre instead personal interpretation; this study aims to provide a guidelines qualitative synthesis for all surgical staff, enclosing basic behaviors for the staff and patient safety in a complex assistant approach on a pandemic time.