Impact of COVID-19 on Elective Surgery: HMIMV Rabat Experience between 15/03 and 15/06 (2018-2019-2020)

Research Article

Austin J Anesthesia and Analgesia. 2022; 10(1): 1103.

Impact of COVID-19 on Elective Surgery: HMIMV Rabat Experience between 15/03 and 15/06 (2018-2019-2020)

Atmani W*, Ayoub B, El Koundi A, Meziane M, Jaafari A, El Wali A, Baite A and Bensghir M

Pole Anesthésie-Réanimation, Hôpital Militaire d’Instruction Mohamed V, Rabat, Morocco

*Corresponding author: Walid Atmani, Pole Anesthésie-Réanimation, Hôpital Militaire d’Instruction Mohamed V, Rabat, Morocco

Received: December 22, 2021; Accepted: January 25, 2022; Published: February 01, 2022

Abstract

In Morocco, the Ministry of Health announces the registration of the first confirmed case of the new Coronavirus, by the Institut Pasteur in Morocco, during the evening of Monday March 02, 2020, at a Moroccan national residing in Italy, Morocco has declared a state of health emergency and confinement as of Friday March 20 at 6 p.m., in order to contain the spread of Covid-19.

Aims: The study aimed to study the impact of COVID-19 on general surgical practice during three months compared to previous years and the future implications of the pandemic.

Methods: Observational descriptive study being carried out in the central operating room of the military hospital in Rabat, evaluating the impact of Covid-19 on the planned surgery by thus comparing the activity of the unit during the three months of confinement March April May between 2018, 2019 and 2020.

Results: The total number of surgeries has decreased to 497 in 12 weeks compared to 2073 at 2018 and 1900 at 2019.

Cancer surgery has seen a decrease of 40% compared to the previous years, this reduction mainly concerns neurosurgery; ENT, and stomatology as for other specialties the number was almost the same.

Benign surgery has seen a decrease of 70% compared to the previous years; all surgery combined has seen a reduction in the number of patients; this reduction is mainly due to the socio-demographic factor, the difficulty of traveling due to confinement.

Keywords: Elective surgery; Oncological surgery; Covid-19

Introduction

The pandemic of COVID-19 caused by the coronavirus SARSCoV- 2 is disrupting global health, social welfare and the economy in a proportion unparalleled in modern history. In addition to the effects of the disease itself on public health, a collateral effect from near-universal disruption and cancellation of surgical services has emerged [1].

The COVID-19 pandemic has disturbed a major part of hospital services routine. During the pandemic hospitals have reduced elective surgery in the interests of patient safety [2-4]. In fact, reducing elective activities protects patients from nosocomial viral transmission and associated postoperative pulmonary complications. This preserves personal protective equipment (PPE) supplies to be prioritised for the care of COVID-19 patients, and releases ward and critical care beds for surges in COVID-19 patients.

Cancelling elective surgery at this scale will have substantial impact on patients and cumulative, potentially devastating consequences for health systems worldwide [5]. Delaying timesensitive elective operations, such as cancer or transplant surgery, may lead to deteriorating health, worsening quality of life, and unnecessary deaths [6,7]. This will lead to deterioration in population health, productivity, and a substantial societal cost.

Guidance is urgently needed on how to deliver surgical services safely and effectively in the face of pressures placed by the COVID-19 pandemic [1-3]. Surgical services need to balance supporting the whole hospital response and minimizing the risk of nosocomial spread of COVID-19 against continuing care for acute surgical conditions and managing urgent elective surgery.

In Morocco, the Ministry of Health announces the registration of the first confirmed case of the new Coronavirus, by the Institut Pasteur in Morocco, during the evening of Monday March 02, 2020, at a Moroccan national residing in Italy, Morocco has declared a state of health emergency and confinement as of Friday March 20 at 6pm, in order to contain the spread of Covid-19.

Aims

The study aimed to study the impact of COVID-19 on general surgical practice during three months compared to previous years and the future implications of the pandemic. Experience of mohamed V military hospital in Rabat.

Methods

Observational descriptive study being carried out in the central operating room of the military hospital in rabat, evaluating the impact of Covid-19 on the planned surgery by thus comparing the activity of the unit during the three months of confinement March April May between 2018, 2019 and 2020 this also made it possible to assess the impact of Covid on cancer surgery and the solutions to be proposed so as not to delay this type of surgery , the study covers all surgical specialties, were included all scheduled surgeries and endoscopic surgery and excluded emergency surgeries.

Organization of surgical activity

During the Covid-19 pandemic, all scheduled surgical activities were postponed. Only surgical emergencies and semi-urgent surgeries (oncological, septic) were maintained at the level of the central block.

The emergency room was made available to intensive care and emergency services as a buffer zone. It was set up to receive patients suspected of Covid-19 while awaiting the results of the PCR. If the test was positive, patients were transferred to the Covid intensive care unit. If the test was negative, the patients were transferred to the noncovid intensive care unit.

Urgent surgical activities were transferred to another ward (septic block).

The two intensive care units (medical and surgical intensive care) were dedicated to the hospitalization of Covid patients. An intensive care unit in the burns department was set up to receive non-Covid patients requiring a stay in intensive care.

For paramedical staff, it was divided into equal teams to provide on-call duty in the three intensive care units. These teams were reinforced by other nurse anesthetists and polyvalent nurses from other departments.

For the medical staff, a reinforcement of the medical teams ensuring daily work and on-call activities has been done. As a result, the majority of residents were assigned to the two intensive care units.

Emergency anesthesiologist activities were carried out by a team of three anesthetists who at the same time provided on-call duty in the non-covid intensive care unit.

Results

The total number of surgeries has decreased to 497 in 12 weeks compared to 2073 at 2018 and 1900 at 2019.

Our results were divided into two categories, oncologic surgery and benign surgery illustrated in Table 1 and Figure 1.