key: cord-0814641-6o1p75l6
authors: Rege, Sameer Ashok; Bandekar, Pooja
title: An Invited Commentary on “Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study”
date: 2020-09-11
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.09.004
sha: cd7bd215dbdcc1226ace16fa3ace9f3ae36fff14
doc_id: 814641
cord_uid: 6o1p75l6

nan

With the declaration of the Covid 19 pandemic in March 2020, the scenario of health care changed all over the world. Due to high infectivity, long incubation period, asymptomatic carriers and in some cases limitations in testing for the disease made many countries opt for lockdowns. This had an effect on elective surgeries, much of which were cancelled with many centres opting only to operate on emergencies. 1 Patients feared seeking help for many acute surgical conditions as they were reluctant to visit hospitals for the fear of contracting COVID themselves. This resulted in their either seeking alternate remedies or waiting until extreme deterioration of the condition. Both of these factors resulted in an increase in morbidity and mortality even when lesser patients presented with acute surgical conditions.

With a sharp upswing in the number of COVID patients, the government policy was mainly directed towards management of the pandemic, resulting either in setting up of new dedicated COVID centres or commandeering existing ones for management of COVID alone. These centres required staffing and thus senior and junior members of the medical staff were diverted there. The same was true for paramedical staff as well. In addition, with a gradual understanding of the effect of COVID on pre-existing comorbidities and increasing age, much of the senior staff opted for telemedicine consultations or the management of COVID patients.

In many cases, patients were unable to seek timely care because of lack of transport due to the lockdown, while many preferred to be treated conservatively to either avoid mixing of COVID or non COVID in a hospital set up or until they were tested to ascertain their COVID status. 2 With healthcare being largely overwhelmed in many countries, there was neither the time nor the expertise to devote to all patients, which without doubt was a much needed factor in management of surgical conditions to ensure that mortality and morbidity was kept to a minimum.

With worsening of several conditions which were actually non emergent had they received attention in a regular non COVID set up, the emergency set ups were now overwhelmed with emergent cases all requiring immediate attention, resulting in a conundrum for the health care personnel involved. The net effect thus seen was an upswing in the incidence of morbidity and mortality of surgical cases when compared to previous records.

Though trauma patients decreased, malignancy progressed towards higher stages due to inaccessibility and elective kept on hold and presented in obstruction, perforations or bleeding complicating the entire surgical path.

Though the personal protection gears (PPE) and respirators were available, performance of the surgical team decreased as not been used to operate with PPE. 3 Additional aerosol formations was much feared while laparoscopic surgery through the gas leak through the ports as less evidence was available leading to surgeons pushing the conventional surgeries adding to the morbidity of the patient. 4 Thus, it would be safe to conclude that while surgical morbidity and mortality has been on the upswing, it was a result of many interconnected factors and thus should not be viewed in isolation, as a result of multiple factors many of which have resulted from a hitherto unprecedented pandemic.

Provenance and Peer review. Invited commentary, internally reviewed.

J o u r n a l P r e -p r o o f

Surgery in Covid -19 patients: operational directives

Acute care Surgery during Covid-19 pandemic in Spain: Changes in Volume, causes and complications. A multicentre retrospective cohort study

Managing covid-19 in surgical systems

Risks of viral contamination in healthcare professional during laparoscopy in the Covid-19 pandemic