If immediate elective surgical procedures will not be started, we expect the vast majority of our patients developing complications.
As the coronavirus (COVID-19) pandemic sweeps across the world, it is causing widespread concern, fear, and stress to the patient who needs elective surgery. COVID-19 is spreading like an uncontrolled fire. While the government is taking steps like lockdown, educating people about social distancing, hand hygiene, etc., most of the hospitals have stopped elective surgeries.
It seems to be the right decision for the hospitals but it has created panic among the patients who need laparoscopic and robotic surgery if elective surgery is not started immediately. There are procedures such as Wall’s that are scheduled in advance. Cosmetic surgery, hernia repair and cancer operations are among the wide range of elective surgeries that come with varying degrees of complexity and urgency.
Many authorities have recommended ceasing all elective surgeries amid the pandemic until the transmission of COVID-19 slows. Some physicians have concerns about performing elective surgeries on asymptomatic COVID-19 patients, fearful that patient mortality and ICU rates can increase significantly for those with unknown infection at the time of surgery. But as per Dr R K Mishra, Director of World Laparoscopy Hospital, Gurugram, a “The decision should be made on a case-by-case basis, taking into account a patient’s prognosis without the procedure.”
According to Dr R K Mishra, delaying, or cancellation of these procedures often rapidly worsens the patient’s condition, potentially turning it into a life-threatening condition. He recommended that the surgeon should determine what is in the patient’s best interest and make a case-by-case evaluation and urgency of the procedure.
Cancelled elective surgeries may also impact on health insurance and other payors, which may cause further financial stress. As most of the hospitals find themselves overburdened in the epicentre of the COVID-19 crisis, they may simultaneously find themselves in a challenging fiscal situation with continued uncertainty ahead.
Location is also a factor for reintroducing elective surgeries. We should develop a process to perform elective surgeries in different specialized hospitals around the country. As World Laparoscopy Hospital is a single super speciality hospital dedicated to laparoscopic and robotic surgery, we cannot help the COVID-19 patients.
At World Laparoscopy Hospital, we cannot treat medical patients and emergencies, so we have less risk of contaminating our staff or patient with COVID-19. We understand that during this pandemic, we cannot help our country to fight against COVID-19. Still, we can perform affordable laparoscopic or robotic surgery and thus help non-corona patients developing complications. Governments should learn to strike a balance between controlling the spread of COVID-19 and allowing elective procedures in the selected hospital who does not deal with COVID-19 patients.
Elective laparoscopic and robotic surgeries and procedures may make up a significant percentage of a hospital or health system. Hospitals treating patients with COVID-19 face uncertain risks because India is still working to flatten the curve of the pandemic. We do not yet know when the curve will begin to flatten, reflecting containment of the virus. Hospitals that only do elective surgery must continue to operate and maintain sufficient capacity to treat patients when we reach the apex of the curve. World Laparoscopy Hospital thus is in an extremely challenging position.
In the multispeciality hospital during elective surgeries, more people visit the hospital, cross-contamination is high risk. Multispeciality hospitals are delaying surgery by avoiding elective surgeries; it encourages social distancing and contaminant of coronavirus infection in OPD and waiting hall. In this situation responsibility of hospitals dedicated to elective surgery is high as they can decrease the load on multispeciality hospitals and give them the room to treat Corona infected patients.
Before elective surgery is resumed in any super speciality hospital, there should be good availability of PPE and a reliable supply chain for at least 30 days of surgery. Consider having all healthcare workers and staff wear appropriate PPE inside and outside the operating room and having all patients wear good quality of masks. A hospital’s available resources should include peri-anaesthesia units, critical care, diagnostic imaging, and lab services. Assess the level of stress and fatigue among healthcare workers during post-operative patient care.
According to Dr R K Mishra, surgeons, anesthesiologists, and nurses should develop strategy, planning and frameworks for minimal access surgery prioritization. They should make a proper decision of cancelled and delayed surgical procedures, a strategy for the phased opening of ORs, PPE availability, and issues related to increased OR volume. The coronavirus is not going to go away soon, so we must learn to live with it.