Invited commentary on "acute care surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicenter retrospective cohort study".

The Covid-19 Pandemic that gripped the whole world had a significant impact on surgical practice affecting both patients and the medical workforce. Oscar Cano-Valderrama and colleagues mentioned delay arrival of patients to the emergency department and decrease numbers of elective procedures [1]. The impact of COVID-19 on surgical workforce and staffing issues highlighted in another article concerning viral transmission risk intra-operatively, staff sickness as well as the impact on surgical education [2].

During the current pandemic, instead of deploying surgical resources for surgical conditions in need, the present requirement for ventilators, hospital space and personnel is depriving surgical capacity to an extent where essential surgical delivery is worn in multiple regions such as operating theatres, number of surgeons and operating staff. Such strain has an immediate and long-lasting repercussion on millions of patients with surgical conditions around the world [3]. In the post-operative phase, patients should be monitored closely as there are indications that previously undiagnosed COVID-19 may complicate post-operative recovery. Postoperative pulmonary complications are not uncommon. Hence, it is vital to consider COVID-19 in both pre-assessment and postoperative period [2].

Long term effects at the institutional level in terms of creating within-hospital pathways for ‘clean’ and ‘contaminated’ patient flow is essential to maintain open routes for regular diagnosis and treatment [3]. One major source of unpredictably is the duration of the acute phase of the pandemic and time needed to go back to regular surgical activities. We must not forget that any form of the surgical procedure we postpone today leaves a patient who will need answers shortly, resulting in a high risk of a rebound effect when the COVID-19 calamity is over [4]. Delaying time-sensitive elective operations, such as cancer or transplant surgery, may lead to deteriorating health, worsening quality of life, and unnecessary deaths [5].

There is no existing knowledge as to what impact this loss of surgical capacity will have on patients’ surgical condition and associated health, or in terms of well-being, functional capacity, risk of loss of function or adverse effects on prognosis [3]. Søreide, K et all suggest we have a structured framework for evaluation of this COVID-19 pandemic concerning surgical care delivery and also a strong advocacy agenda is needed that includes investigation, planning, research and communication for surgical and anesthesia services for future pandemics [3].

Provenance and peer review invited commentary, internally reviewed.