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COVID-19 and Surgical Preparedness
Table 4: Practices for COVID-19 protection
Private sector Public sector
respondents (n = 238) respondents (n = 80) OR (CI) p value
Patients tested for COVID-19 before elective surgery 192 (89.7%) 22 (10.2%) 11.04 (6.11–19.76) 0.000
(n = 214), i.e., 67.2%
Taken/intend to take hydrochloroquine 114 (67.0%) 56 (32.9%) 0.39 (0.22–0.67) 0.0007
recommended by ICMR (n = 170), i.e., 53.4%
Taking immunity boosters (n = 213), i.e., 66.9% 165 (77.4%) 48 (22.5%) 1.50 (0.81–2.58) 0.06
Operating with basic minimum surgical team (n = 31), 26 (83.8%) 5 (16.1%) 1.83 (0.68–4.96) 0.11
i.e., 9.7%
Cut down on aerosol-generating procedures (n = 43), 32 (74.4%) 11 (255%) 0.97 (0.46–2.03) 0.46
i.e., 13.5%
Prefer open surgery to laparoscopic surgery (n = 62), 36 (58.0%) 26 (42.0%) 0.37 (0.20–0.66) 0.0006
i.e., 19.4%
Usually defer elective surgery due to COVID-19 scare (n = 24), 15 (62.5%) 09 (37.5%) 0.5 (0.22–1.26) 0.08
i.e., 5.9%

compared to nine (37.5%) from public sector due to COVID-19 of participants in their surgical setup affirmed to have standard
scare (p >0.05). Thirty-one participants (9.7%) were operating with protocols and triage for COVID-19 patients, further private sector
minimum surgical team, 26 (83.8%) public sector, and 5 (16.1%) is 1.68 times more likely to have protocol surgical management
private sector (p = 0.11). of COVID-19 cases compared to public sector (p = 0.02). Similarly,
A total of 62 respondents implied that they would prefer open 44.9% of the respondents reported the presence of dedicated
surgery to laparoscopic surgery of which 36 (58%) were in private COVID-19 postsurgery recovery wards. This facility was more with
sector and 26 (42%) in public sector. Surgical practitioners in private private sector participants—118 (82.5%), as compared to public
sector were less likely to prefer open surgery to laparoscopic healthcare providers—25 (17.4%), p = 0.006.
surgeries OR = 0.37 (0.20–0.66), and the difference was found to In view of aerosol transmission of COVID-19, a dedicated
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be highly statistically significant (p <0.001). operation theater with negative pressure is required. In our study,
Of the 170 respondents who had consumed hydrochloroquine we found that just 34 (10.6%) of the respondents admitted to
as recommended by the Indian Council of Medical Research (ICMR), having a negative-pressure operation theater, and there was no
114 (67%) were private practitioners and 56 (32.9%) were public statistically significant difference between public and private care
healthcare sector professionals. The odds of the health providers in in relation to availability of negative-pressure operation theater
public sector consuming hydrochloroquine were 0.39 times lesser (p = 0.2). Considering the logistics and cost involved in redesigning
than those in private sector, and the difference in consumption of operation theater complexes with negative-pressure facility, it
hydrochloroquine was highly significant among the two groups seems to be a near impossible recommendation to implement.
(p <0.001). However, no statistically significant differences were The UK and Ireland surgeon colleges have recommended to stop
found in the two groups as far as the consumption of immunity positive-pressure ventilation during the procedure and 20 minutes
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boosters was concerned (p = 0.06). after the patient has left the operation theater. The risk of surgical
smoke has been recognized since a long time, advent of COVID-19
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has brought into sharp focus again. Apart from operating room
dIscussIon setup, theater personnel and surgical equipment are other means
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The COVID-19 infection caused by severe acute respiratory to manage harmful effect of smoke. Mowbray et al. have discussed
syndrome coronavirus-2 (SARS-COV-2) after its origin in China in various filters, extractors, and nonfilter devices to manage surgical
December 2019 has overwhelmed the healthcare systems across smoke. In our analysis, 43 respondents stated to have cut down on
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the world. A major challenge for the surgical society is to maintain aerosol-generating procedures of these majority 32 (74.4%) were
the provision of essential services while at the same time preserving in private sector as compared to 11 (25.5%) in public sector. No
the precious resources and preventing exposure to healthcare statistically significant difference was found in these two groups
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personal. The Indian Government declared complete lockdown (p = 0.46). Various surgical associations have recommended a
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on March 24 with further extension till May 4 on April 14. Initially minimum number of operating room staff while performing
all the elective surgery work both in private and public sector was surgeries. 11,12 In our study, 9.7% of the respondents confirmed to be
suspended completely. This impact of COVID-19 on surgeons’ following operation with minimum staff members (n = 31). Larger
daily practice and education was profound. This study is an online number was from private sector—26 (83.8%), in comparison with
survey with the aim to know the status of preparedness of surgical private sector—5 (16.1%). However, the difference was statistically
community in conducting routine work in the ongoing pandemic. insignificant (p = 0.11).
Response of 318 participants (238 private sector and 80 public The risk of airborne transmission of virus is a possibility in both
sector) were analyzed. open and laparoscopic surgeries because both have propensity to
In our study, mean age of the respondents was 42.3 ± 10 years, generate aerosols. Li et al. suggested that risk in open surgery is
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with 40.8% of respondents from general surgery specialty. As less as artificial pneumoperitoneum is not created. The UK and
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expected large number of participants were male with a male- intercollegiate board has stated that “laparoscopy is considered
to-female ratio of 2.38:1. Our study has shown that only 52.2% to carry some risks of aerosol-type formation and infection and

188 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)