Surgery during the COVID‐19 pandemic: operating room suggestions from an international Delphi process

Abstract

Introduction

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 characterise 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% UK). Consensus was reached on 71/100 statements, predominantly standardisation of OR pathways, OR staffing, and pre‐operative screening or diagnosis. The highest levels of consensus were observed in statements relating to appropriate personal and protective equipment (PPE) and risk distribution (96‐99%), clear consent processes (96%), multidisciplinary decision‐making and working (97%). Statements yielding equivocal responses predominantly related to technical and procedure choices, including: decontamination (40‐68%), laminar flow systems (13‐61%), PPE reuse (58%), risk stratification of patients (21‐48%), open vs. laparoscopic surgery (63%), preferential cholecystostomy in biliary disease (48%), and definition of aerosol generating procedures (19%).

Discussion

High levels of consensus existed for many statements within each domain, supporting much of the initial guidance issued by professional bodies, yet several contentious areas arose, which represent urgent targets for investigation to delineate safe COVID‐19 related OR practice.

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