Surgery in the Coronavirus era
A vaccine for coronavirus is at least several months away. Therefore hospital surgeons and patients are having to adapt their practices and expectations to minimize the risk of inadvertent coronavirus transmission to patients. These changes are happening simultaneously in the NHS and private sector often with precedent-setting cooperation between the two as large swathes of the private sector have been temporarily incorporated into the NHS during the pandemic. As surgeons we are having to risk stratify our patients. This means that we are deciding which patients that are waiting for surgery are the most urgent and operating on them first. This is in contrast to the pre-Covid era when most operating lists would involve a combination of patients whose condition was urgent and those whose condition was not necessarily urgent but had been waiting a long time for surgery. Most plastic surgery patients are being treated for a condition that is not life-threatening and therefore plastic surgeons are having to robustly defend their patient’s interests in order to gain access to sufficient operating lists both in the public and private sectors.
However, the time for surgery will come for all of our patients. There are many things we can do to minimize the risk of coronavirus for patients having surgery. Patients and staff are being tested for coronavirus prior to coming to hospital. Patients Are being asked to self isolate prior to surgery and surgeons are being asked to avoid Covid positive areas of hospitals prior to coming to surgery. There are strict measures in place in hospitals and clinics with regard to the wearing of personal protective equipment and social distancing. To begin with we are avoiding long operations that require prolonged hospital stays at least until our infection prevention protocols have been tried and tested. So to begin with we are starting with day case procedures. Putting someone to sleep for an operation is what is known as an aerosol generating procedure and is therefore a high risk moment for Coronavirus transmission that puts the Anaethetist at particular risk. Therefore we are trying to do as many cases as possible under a local anaesthetic when the patient stays awake.
As a patient I am you should ask yourself whether you can wait for surgery or not. Clearly the risk of contracting coronavirus have to wait up against the harm that comes from the lane surgery. The answers this will vary from patient to patient. Patients who have one more serious illnesses or a greater risk from becoming very unwell with coronavirus and so these patients if possible I probably best advised to d
elay surgery until we have a vaccine. Patients who are generally healthy I’m not in any of the at risk groups may reasonably judge that their risk of becoming seriously unwell with coronavirus of surgery is low. We do know that coronavirus does increase the risk of death after surgery but this is mainly in patients who are having emergency surgery which is a very different scenario to Patients having routine planned surgery. The other factor to consider is your own immunity. Around one and five staff tested for coronavirus antibodies have tested positive in the NHS hospitals I work at. We don’t know yet whether having had the coronavirus once you are subsequently immune to catching it again. But for most diseases exposure does confer some immunity. Therefore if you’ve had Covid you might reasonably judge yourself to be at less risk of developing the virus after surgery if you are unfortunate enough to come into contact with it. In my own practice I am trying to treat all of my urgent patients, particularly children, as a priority but I am not planning to unduly delay surgery on any of the rest of my patients because I believe that with proper precautions the risk of coronavirus transmission can be minimised to an acceptable degree.