Cutting back on surgeries during Covid-19

Universiti Kebangsaan Malaysia Medical centre consultant ENT surgeon Prof Dr Marina Mat Baki conducting a surgical simulation with plastic coveralls to practise preventing aerosolisation in an aerosol-generating procedure for Covid-19 patients, assisted by the writer. — Photos: Dr HARDIP SINGH GENDEH

Frontline and critical care services are being prioritised as they are dealing directly with Covid-19 patients. However, essential or emergency surgical care is still being performed, although such operations have to be carried out in a way that minimises risk to both patient and surgeon. As for non-Covid-19 hospitals, it is business as usual for all emergency and non-emergency surgeries.The College of Surgeons, Academy of Medicine Malaysia, has provided guidelines since the beginning of the movement control order on how to conduct surgery during this time, including on triaging and prioritisation of surgeries.

CSAMM president and Universiti Malaya Medical Centre consultant colorectal surgeon Professor Dr April Camilla Roslani says that healthcare institutions should consider the following three factors in deciding which surgical cases require immediate attention and intervention:Bed and manpower capacity of the hospital, andAnother factor is that anaesthesiologists are required to sedate patients for surgery.

If surgery must be done, there should be a discussion among all the specialities caring for the patient to deliberate on the safety of the procedure, especially as Covid-19 patients need to be managed meticulously to limit cross-infection. Prof April notes that the CSAMM has provided guidelines on how and when to conduct surgeries during the current pandemic. — Filepic

When the Covid-19 status is unknown, the surgical team consisting of the anaesthesiologist, surgeon, operation theatre nurse and healthcare assistants, are required to act as if the patient has Covid-19 and don the appropriate PPE. After surgery, patients need to be admitted to designated Covid-19 wards or ICUs where healthcare workers are required to be in full PPE.

Therefore, many surgeons will have to use conventional surgical instruments with limited technological assistance.

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