EA21 Newsletter: Session COVP1: Different perspectives looking back at Covid pandemic

Friday December 17, 17:45 – 18:45 – Channel 8

This three-part session reflecting on the COVID-19 pandemic to date will be opened by Dr Kariem El-Boghdadly, Consultant Anaesthetist at Guy’s & St Thomas’ NHS Foundation Trust, London, UK, who will discuss the timing of surgery after SARS-CoV-2 infection.

He will explain how surgery with active SARS-CoV-2 infection is associated with increased risks of complications and death. With an increasing number of patients having surgery after a recent or previous SARS-CoV-2 infection, there was a need for evidence to guide the safest timing of surgery in this growing cohort of patients. An international across 116 countries study of more than 140,000 patients was conducted, finding that the risks of death and complications were increased if surgery was performed within 7 weeks of a SARS-CoV-2 infection.

Patients with ongoing symptoms had a greater risk than those who have had symptom resolution. These risks remained high regardless of how unwell the patient was, and the nature and urgency of the operation they were having. These data fed into national guidelines in the UK by the Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England, who recommended that planned surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV-2 unless the risks of delaying surgery are greater than the risks associated with COVID-19. Dr El-Boghdadly concludes: “These recommendations should increase the safety of surgery in patients who have had SARS-CoV-2 infection.”

The second talk in this session – ‘Lessons learned from Covid: the surgeons’ perspective’ – will be presented by Prof Dr Nicole Bouvy, a surgeon at Maastricht University Medical Center, Netherlands.

She says: “The COVID-19 pandemic and the lack of space in the operating rooms made us realise which surgical procedures are really important and which patients cannot be placed on a long waiting list. Patients on the waiting list for elective surgical procedures like hernia surgery realised that living with a for example non-symptomatic inguinal hernia at the age of 70 is not a big thing. By discussing OR indications in a multi-disciplinary team we learned a lot about real sensible care.”

Central OR planning makes the planning more effective so that the OR is fully occupied. Most of the time, procedures planned by plastic and reconstructive or orthopaedic surgeons had to be placed back on the waiting list. Prof Bouvy says: “Of course, we must find out if the quality of life of these patients is impaired.”

She adds: “Furthermore, this time of reflection helped us to make our operating room more sustainable. As hospitals are responsible for 25% of the total greenhouse effect in western countries, we started with a reduction of inhalation gases, a reduction of the air refreshment cycle and a reduction of our disposable instruments. Also, because raw materials were hard to get other materials were hard to get. This ‘green spirit’ in the hospital helped to better team building and makes the environment and people living in the neighbourhood of the hospital healthier.”

The final talk “Pain management beyond the pandemic. Latin American experience” will be given by Dr Carolina Haylock Loor (San Pedro Sula Hospital, Honduras).

She explained how, during the COVID-19 pandemic, the human family has experienced an extremely challenging situation, with massive uncertainty, impacting all dimensions: physical, emotional, spiritual, political, economic, social, technological, influencing the quality of life globally, bringing more suffering and pain.

“Latin American is no exception,” says Dr Haylock Loor. “With more than 600 million inhabitants, Latin American is considered the world’s most unequal region, and the pandemic has increased this inequality (GINI coefficient raised from 0.48 to 0.51). This discrepancy also occurs in pain and reaffirms the WHO publication in 2009 that ‘80% of the world population with moderate to severe pain lack of adequate access to pain treatment’, and with stressors of the pandemic, like loneliness, distancing, it persisted and worsened.”

The increasing global burden of pain, more notorious in LMICs, by trauma, post-operative, childbirth, arthritis, back pain, diabetes, cancer, HIV-AIDS, sickle cell disease, and now post-COVID-19 syndrome, results in more inequity and compelling a need for bridging the gap in this regional health issue. Although there is a lack of epidemiological data in Latin America, there are studies that estimate a prevalence of chronic pain in a range of 18 to 42% of the population. Another disparity is in medicines for treating pain. HICs use 90% of the morphine distributed worldwide and experience the opioid addiction crisis, while in contrast, LMICs use only 10% of the world’s opioids and suffer opiophobia, in Latin American due to unfounded fear of medical professionals to provoke addiction with their prescriptions, aggravated by limited opioid availability, lack of education in pain, healthcare policies with strict regulatory provisions and finally, untreated conditions that enlarge the burden of pain.

She concludes: “In summary, pain does not wait for the pandemic to end; in Latin America, we started its management with telemedicine, in-person assessments, interventional procedures, pharmacological and non-pharmacological approaches. We must continue managing and educating our pain patients and trainees without tiring to struggle in the region to overcome the barriers mentioned.”

Read More of our special newsletter covering our virtual congress.