Take home message
What we have learned during this webinar is that it is not possible to give strict suggestions about how to resume elective surgery. This is completely understandable and normal: conditions differ not only from country to country, but also from city to city, even from center to center.
The webinar helped us focusing on what we have in “scales of the balance”: On one scale, we have – and this is the most important part – many patients, waiting since a long time to be operated, with tumors or heart failure, whose health is getting worse every day.
At the same scale we have also the financial issue, that even we, as doctors, should not ignore.
But on the other scale we have to keep in mind the constant risk of contracting and spreading COVID-19 infection. In fact, it is never (and nowhere) possible to extensively isolate covid (+) and covid (-) patients: Tests are never enough sensitive and specific. There is (and will always be) a risk of contagion, both for doctors and patients.
The webinar helped us:
1. In making “better” decisions regarding the different factors in the scales of the balance.
2. In decreasing the risks both for the patients and for the health personnel during the pre, intra-, and postoperative period.
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Check below the programme, speakers and answers to not addressed questions during the webinar
Summary: EACTA webinar: Resuming Elective Cardiothoracic Surgery during COVID-19 Outbreak
Dr. Hans-Christian Zaun, Ph.D. Scientific Advisor, MULTILEARNING GROUP.
This webinar on Resuming Elective Cardiothoracic Surgery during the COVID-19 Outbreak is hosted by Dr. Mert Senturk of Istanbul University, Istanbul, Turkey, and moderated by Dr. Laszlo Szegedi, from Brussels, Belgium and Dr. Mohamed El Tahan of Mansoura University, Egypt, and Imam Abdulrahman Bin Faisal University, Saudi Arabia.
The first speaker, Dr. Turgay Tuna of CUB Hospital ERASME, Brussels, Belgium, begins the webinar by discussing the economic impacts that COVID-19 pandemic had on hospital settings in Belgium. He begins by discussing the COVID-19 pandemic in Belgium and his institution, particularly the economic implications due to the cessation of elective surgeries. The postponement of elective surgeries resulted in considerable losses to hospital revenue, and financial resources allocated to the hospitals for staff infrastructures and supplies will not nearly be enough. He also discusses the issue of short-term absenteeism among hospital staff due to suspected COVID-19, and with the resumption of elective surgeries, increased staff and materials will be critical.
Dr. Alexander Wahba from St. Olavs University Hospital in Trondheim, Norway, continues the webinar by discussing patient assessment for returning to elective cardiac surgeries in a dedicated COVID-19 hospital. He begins by discussing the COVID-19 pandemic in Norway and at St. Olavs Hospital as well as the differences between Norway and other European Nations. Of particular note was that in Norway, the centralized management of personal protective equipment (PPE) resulted in the transfer of supplies to the hospitals where they were most needed. Dr. Wahba states that the main obstacles with the restoration of elective surgeries will most likely include shortages of PPE and ICU capacity. However, the increased risk of COVID-19 infection will also be a factor. He addresses several crucial recommendations that include a gradual increase in elective surgeries, testing of patients and staff, reduction in the number of personnel in one place, and finally, the use of prognostic tools to better prepare for different scenarios in the future.
Dr. Alessandro Brunelli of St. James University Hospital, Leeds, UK, discusses elective thoracic surgeries in a dedicated COVID-19 hospital. After reviewing the pandemic situation in the UK, he examines several vital factors in deciding which patients should undergo elective surgeries. He presents numerous protocols, guidelines and recommendations from multiple organizations and publications on the gradual return to elective surgeries. When selecting which patients will undergo surgery, several factors must be considered. These factors include the availability of resources, alternative treatments, surgical risk, as well as the long-term prognosis. Dr. Brunelli concludes with various recommendations on how to stratify patients based on risk assessment.
Dr. Steffen Rex from the University Hospitals Leuven, Belgium, discusses the reduction of risk by preoperative assessment and optimization. He begins by explaining how the postponement of elective cardiothoracic surgeries has resulted in numerous indirect implications that may increase overall mortality. Of particular interest, Dr. Rex discusses how the pandemic has resulted in a reduction of admissions related to cardiovascular disease, even though a higher incidence of heart attacks would be expected. He explains this paradox is primarily due to the avoidance of medical care due to social distancing, fear of contracting COVID-19 as well as STEMI misdiagnosis. He then provides a roadmap for the reopening of elective surgeries, as well as prioritizing and scheduling operations. Finally, he discusses preoperative screening and assessment and gives several recommendations.
The final speaker, Dr. Fabio Guarracino, from the Azienda Ospedaliero Universitaria Pisana, Pisa, Italy, presents numerous tips and strategies for both the intraoperative and postoperative procedures to reduce the risks of contagion for both patients and hospital staff. It is crucial to understand where these risks originate, mainly the numerous aerosol-generating procedures and lung resections. Dr. Guarracino discusses the importance of PPE, transportation and preparation of COVID-19 patients, as well as proper operating theatre organization. Dr. Guarracino concludes by stating that it is imperative that the medical community learn from their experiences during the pandemic, and particularly highlight any errors where things can be improved. Planning for the second wave, and a progressive resumption of elective surgeries is crucial.
After joining this webinar, you will better understand:
- Impacts of long-term lockdown during the COVID-19 outbreak;
- Considerations and consequences of returning the elective cardiac and thoracic surgery during the COVID-19 era;
- Changing routines of the perioperative care to minimize risks for returning the elective cardiothoracic surgery.
Cardiac, thoracic and vascular anaesthetists and surgeons, healthcare business professionals, intensivists, perfusionists, general anaesthetists, anaesthesia certified nurses, nurses, interns, and medical students.