PROTECTION PROTOCOLS DURING EMERGENCY OPERATIONS FOR PATIENTS WITH CONFIRMED OR SUSPECTED COVID-19 INFECTION
We can and should try to avoid elective operations during the outbreak. However, we cannot avoid emergency surgery, even for individuals with confirmed or suspected COVID-19 infection. In these circumstances, all medical workers participating in the care of patients with confirmed or suspected COVID-19 infection need three-level protection, including medical masks, protective clothing, goggles/protective masks, double gloves, shoe covers, etc. All staff who participated in the care of these patients should undergo medical observation for 14 days after surgery. Patients undergoing emergency surgery should remain isolated from the preoperative preparation stage to postoperative treatment, and they must wear masks at all time. For operations in the central areas with continuous outbreak of the epidemic, even for patients without confirmed or suspected infection, reverse transcription polymerase chain reaction of samples taken from upper naso-pharyngeal swabs should be performed and preoperative preparations should be made immediately before the operations. If the test result is negative, it is recommended that patients remain in an isolation ward, and a three-level protection protocol should be adopted during the operations. For patients with a negative result before surgery, after intubation, the lower respiratory tract secretions should be tested again.
Surgery shall be performed in an independent negative pressure operating room, and the number of participants shall be limited. After entering the operating room, no one shall enter or leave arbitrarily. All supplies shall be in the charge of nurses outside the operating room. Intubation should be performed after anaesthesia. A disposable filter should be arranged between the tracheal intubation and the respiratory tract to reduce contamination of the respiratory tract. More attention should be devoted to protection when suctioning sputum, and suction should be performed in a closed environment. During the operations, the use of energy devices and energy power should be reduced, to limit aerosol caused by the devices. For examination, surgical specimens should be sealed in double-layered bag. After surgery, the operating room should be disinfected thoroughly, and it can be reused only after passing a sampling test by the infection management department.
Some patients undergoing elective surgery who could not wait for too long because of the disease condition, should be observed in a transitional ward for 2 weeks. Two weeks before surgery, patients should have a chest CT for COVID-19 screening, and routine blood assay, C-reactive protein, procalcitonin, influenza A and B examination within 1 week. If infection is suspected, a further upper nasopharyngeal swab test for COVID-19 should be performed. In fact, all patients should undergo a swab test before surgery.
Postoperative fever, shortness of breath and cough are common clinical manifestations for surgical patients. Fever can be caused by postoperative absorption and bacterial pneumonia of the respiratory tract or pleural infection. Postoperative chest tightness and shortness of breath are also common, due to bacterial pneumonia, atelectasis and acute respiratory distress syndrome. Rare causes include pulmonary embolism, pulmonary volvulus, interstitial pneumonia and bronchopleural fistula. These cases should be identified carefully and differentiated in a timely manner. In addition, because of symptom overlap with COVID-19 infection, these conditions should be differentiated from COVID-19.
In the context of the current COVID-19 pandemic, thoracic surgeons should avoid surgery for benign tumours. Even for malignancies, strict control of the indications for operations is recommended, comprehensive treatment should be emphasized, and alternative treatment strategies should be implemented to avoid COVID-19 infection in hospital and ensure medical safety and quality.
Conflict of interest: none declared.