Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices.

BACKGROUND

In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.

METHODS

During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100).

RESULTS

A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%;

CONCLUSIONS

This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions.

STUDY REGISTRATION

Registered in ClinicalTrials.gov: NCT04344197.

Informations de copyright

Copyright © 2020 by the Journal of Global Health. All rights reserved.

Déclaration de conflit d'intérêts

Authorship contributions: Study conception and design: VB, TK, GP, YA, BS, GS. Acquisition of data: VB, TK, YA, BS, LS, BP, MF, MC. Analysis and interpretation of data: VB, TK, YA, AP, KK, SE. Drafting of manuscript: VB, TK, YA. Critical revision: GP, AP, BS, LS, KK, BP, MF, MC, SE, GS. Final approval: All the authors. Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.