Surgery during the COVID‐19 pandemic: operating room suggestions from an international Delphi process

Background Operating room (OR) practice during the COVID‐19 pandemic is driven by basic principles, shared experience and nascent literature. This study aimed to identify the knowledge needs of the global OR workforce, and characterize supportive evidence to establish consensus. Methods A rapid, modified Delphi exercise was performed, open to all stakeholders, informed via an online international collaborative evaluation. Results The consensus exercise was completed by 339 individuals from 41 countries (64·3 per cent UK). Consensus was reached on 71 of 100 statements, predominantly standardization of OR pathways, OR staffing and preoperative screening or diagnosis. The highest levels of consensus were observed in statements relating to appropriate personal protective equipment (PPE) and risk distribution (96–99 per cent), clear consent processes (96 per cent), multidisciplinary decision‐making and working (97 per cent). Statements yielding equivocal responses predominantly related to technical and procedure choices, including: decontamination (40–68 per cent), laminar flow systems (13–61 per cent), PPE reuse (58 per cent), risk stratification of patients (21–48 per cent), open versus laparoscopic surgery (63 per cent), preferential cholecystostomy in biliary disease (48 per cent), and definition of aerosol‐generating procedures (19 per cent). Conclusion High levels of consensus existed for many statements within each domain, supporting much of the initial guidance issued by professional bodies. However, there were several contentious areas, which represent urgent targets for investigation to delineate safe COVID‐19‐related OR practice. Antecedentes La práctica en el quirófano (operating room, OR) durante la pandemia por la COVID‐ 19 se basa en principios básicos, experiencias compartidas y literatura reciente. Este estudio tuvo como objetivo identificar las necesidades de conocimiento global del personal de quirófano y caracterizar la evidencia existente para establecer un consenso. Métodos Se realizó un estudio basado en una metodología Delphi modificada y rápida, abierta a todos los interesados y a través de una evaluación colaborativa internacional online. Resultados El procedimiento de consenso fue completado por 339 personas de 41 países (64% Reino Unido). Se llegó a un consenso en 71/100 ítems, predominantemente en relación a la estandarización de los circuitos en OR, la dotación de personal y el cribaje preoperatorio o el diagnóstico. Los niveles má