Challenges in providing surgical care during and after COVID-19 pandemic

COVID-19 has changed the way clinical practice and orthopedic care services existed. The pandemic has affected almost all types of health-care delivery, more importantly the surgical care of patients. Although there have been a flurry of opinions and scientific reports on health-care delivery during and after the COVID-19 pandemic, no established consensus exists on the guidelines to the surgical care of patients. We summarize the available evidence on the principles and guidelines to be followed in the care of the surgical patient. Care starts with precautions of infection prevention and care in the outpatient department, which includes sufficient protection of the medical staff, planning to avoid crowding, and smart usage of resources and workforce. Surgery should be contemplated only when absolutely indicated. Surgical care of the patient should encompass not only the prevention of morbidity associated with operating on COVID-19 patients but also the prevention of transmission of infection to other health-care staff and non-COVID-19 patients. Precautions should be taken at multiple levels and include but are not limited to proper preoperative, anesthetic, and surgical considerations and a coordinated functioning of the COVID-dedicated Operating Room (COR). The health-care personnel should be trained on the dos and don'ts in every step in the execution of a surgical procedure on a COVID-19 patient. Senior health-care staff need to overlook the adherence of the health-care personnel to these guidelines. Sanitization of the OR and disposal of infected material carry prime importance after the procedure. In all, it is necessary to accept the new normal resulting from the COVID-19 pandemic to better accept and execute protective measures.