1 Mashhad University of Medical Sciences, Iran

2 Shaheed Beheshti University of Medical Sciences, Dental school. Tehran, Iran


Background: COVID-19 epidemic rapidly spread all around the world with over 1500 thousand infected cases and
95000 deaths. This rapid pandemic may overwhelm health care capacity and shortage of resources is a major concern.
Literature provided guidelines on management of COVID-19 patients but healthcare service to the normal population
should be continued meanwhile. Health system should act immediately and wisely to support essential surgical care while
fighting against COVID-19.
Methods: We conducted a comprehensive search in the major data bases since 2020, using the combination of MeSH
words of “COVID-19 “ and “surgery” and finally 34 full texts entered to data extraction phase to define a plan for surgical
practice during COVID-19 pandemic.
Results: Healthcare workers are at the higher risk of contamination by COVID-19 especially in early stage of outbreak
when they were not aware of the different aspects of COVID-19 pandemic. All healthcare staff must be trained to
properly use PPE. All patients have to be screened at the hospital triage. All elective surgical interventions must be
postponed. Operation room is considered as a place with high risk of cross infection so the highest level of protection
should be maintained. Anesthesia, endoscopy and oral surgery are considered as aerosol producing procedures
with very high risk of contamination. There is not any evidence to support the risk of infection trough blood products.
Postoperative respiratory problems are more common among COVID-19 patients that may increases the estimated
risk of morbidity and mortality.
Conclusion: COVID-19 pandemic is a dynamic challenge for health system to save the healthcare staff and
equipment resources by timely decisions. Healthcare workers are at the higher risk of contamination by COVID-19
especially in early phase of epidemic when the protection is sub-optimal.
Level of evidence: III