COVID-19: a test of evidence-based surgery

Editor

We read with great interest the correspondence from Agrawal and Sharma¹, which highlighted the paucity of evidence behind many of the fears during the COVID-19 pandemic.

It concerned us that, when exposed to the unprecedented stressor of COVID-19, much of the guidance to the surgical community reverted to traditional eminence-based medicine rather than using high-quality scientific evidence. This has resulted in differing advice for key issues, and created considerable uncertainty.

In April 2020 we combined findings from rapid reviews of the literature with the clinical acumen of an expert working group to produce evidence-based guidance for three debated topics: intraoperative practice for laparoscopic versus open surgery, personal protective equipment, and surgical triage. We believe it is telling that despite a ‘tsunami of publications’¹ since then, our ongoing monitoring of the literature has resulted in none of the initial recommendations requiring revision. Review of the existing scientific evidence and the small number of high-quality studies relating to COVID-19 were sufficient for us to outline measured precautions tailored to the theoretical risks of SARS-CoV-2.

We believe that the widespread adoption of an evidence-based approach provides the best chance of achieving a consensus across the surgical community during the COVID-19 pandemic. Clinical activity should be modified only when there is adequate justification, and precautionary measures need to be tailored and controlled. The answer to challenging questions for surgical practice should first be sought from inspection of published data, and then from the opinion of experts. As COVID-19 continues to spread, we cannot know what lies ahead, but we can be guided by scientific truth that is already known.