This article presents an analysis of the preoperative preparations for elective surgical procedures during the pandemic. It covers several issues such as resumption of surgical procedures, preoperative evaluation, screening tests, preoperative screening, PPE and reorganization of surgical practice. 

Surgeries should be resumed on the basis of the existing number of Covid-19 cases and hospitalizations. As per the ‘Elective Surgery Acuity Scale’ defined by the American College of Surgery recommendations, only cancer and high-acuity cases be given the priority for interventions. A joint statement of American College of Surgeons, American Society of Anesthesiologists, Association of peri Operative Registered Nurses American Hospital Association and Royal Australasian College of Surgeons recommends evaluating patients for symptoms of Covid-19 prior to the surgical intervention. This can be done via telemedicine in addition to laboratory tests and imaging. Many patients may have asymptomatic COvid-19 infection or they may be presymptomatic. Hence, every patient should be tested for Covid-19 with RT PCR 1 or 2 days before the surgery. Patients are also recommended self-quarantine from the day of test to the day of surgery. If the patient tests positive, the procedure is delayed until the patient has tested negative and has recovered from the infection. This review also talks about collecting sputum via tracheal aspiration in intubated patients to test for SARS CoV-2. The article further suggests reducing the traffic in ORs to check spread of infection. The ORs for confirmed or suspected cases should be negative pressure rooms. Alternatively, 99% of the air in the OR has been exchanged with regard to air circulation cycling time. Ultraviolet disinfection is recommendation. Reduce aerosol generation by minimizing use of cautery during operations and use of insufflation systems with ultra-low particulate air (ULPA) filters. Standard precautions, droplet precautions and contact precautions are mandatory for every patient, including in the OR. For this all healthcare workers should be provided appropriate PPE. The authors also recommend using CT chest only for surgeries like thoracic procedures and not as a routine screening method. 

Source: Cimen C, et al. Clin Microbiol Infect. 2021 Jan;27(1):16-18.