Comment on: COVID-19 outbreak and the practice of surgery: do we need to change?

Editor

We read with interest the above study¹. Certain observations regarding universal preoperative testing in this study conducted at the peak of pandemic in Northern Italy are noteworthy. Testing in all patients detected only 2/ 134 positives and only one patient developed COVID-19 infection postoperatively. Moreover, RT-PCR testing is <90% sensitive and it is affected by sample techniques, error-free transfer, the timing of tests with illness, genetic diversity prevalent in the region, viral load kinetics, and control techniques adopted². ‘Selective’ use of preoperative testing only for suspected patients (symptomatic, contact, or patient from the high-risk area) has been safely followed by authors from Korea and the United Kingdom at the peak of their pandemics^3,4.

Our tertiary referral teaching center in Central India offers surgical services to a population of 1·1 million (600 COVID positive cases as on 18^th July 2020). Our hospital shut down elective surgical services in the last week of March 2020; which were resumed from 1st May 2020. 161 consecutive patients underwent elective surgery between 1^st May and 30^th June 2020. We followed “selective” (only in suspected) preoperative testing according to the Indian Council of Medical Research requirements⁵. Safe surgical outcome was seen in our cohort with minimal morbidity and mortality, and none of the patients or attending Health Care Professionals developed COVID-19. However, we are vigilant; and as and when the disease spread or the number increases locally, we would apply stricter preoperative screening and testing.

As the end of this pandemic is nowhere to be seen; due consideration has to be given to local testing abilities, priorities, and resource optimization; especially in the global south. Selective preoperative testing with continuous vigilance syncs with the ‘glocal’ approach to disease management in which global knowledge is combined with local resources and wisdom.