Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process
Alexander Williams, Andrew J. Beamish, Christopher Brown, David Robinson, Elizabeth Ryan Harper, Katie Mellor, Luke Hopkins, Oliver Luton, O James, Rhiannon Harries, Rhys Thomas, Richard Egan, Sophie Lewis, Tarig Abdelrahman, T.R. Jeffry Evans, Wyn G. Lewis
Abstract
BACKGROUND: Operating room (OR) practice during the COVID-19 pandemic is driven by basic principles, shared experience and nascent literature. This study aimed to identify the knowledge needs of the global OR workforce, and characterize supportive evidence to establish consensus. METHODS: A rapid, modified Delphi exercise was performed, open to all stakeholders, informed via an online international collaborative evaluation. RESULTS: The consensus exercise was completed by 339 individuals from 41 countries (64·3 per cent UK). Consensus was reached on 71 of 100 statements, predominantly standardization of OR pathways, OR staffing and preoperative screening or diagnosis. The highest levels of consensus were observed in statements relating to appropriate personal protective equipment (PPE) and risk distribution (96-99 per cent), clear consent processes (96 per cent), multidisciplinary decision-making and working (97 per cent). Statements yielding equivocal responses predominantly related to technical and procedure choices, including: decontamination (40-68 per cent), laminar flow systems (13-61 per cent), PPE reuse (58 per cent), risk stratification of patients (21-48 per cent), open versus laparoscopic surgery (63 per cent), preferential cholecystostomy in biliary disease (48 per cent), and definition of aerosol-generating procedures (19 per cent). CONCLUSION: High levels of consensus existed for many statements within each domain, supporting much of the initial guidance issued by professional bodies. However, there were several contentious areas, which represent urgent targets for investigation to delineate safe COVID-19-related OR practice.