29th May 2020

University of Birmingham and College of Surgeons, Academy of Medicine of Malaysia news release

COVID-19 patients who undergo surgery are at increased risk of postoperative death - global study

  • Patients are at increased risk of dying after surgery if they contract COVID-19
  • Non-critical surgery should be postponed during COVID-19 outbreaks
  • Investment is urgently needed to increase safety of surgery during COVID-19 outbreaks

Patients undergoing surgery after contracting coronavirus are at greatly increased risk of postoperative death, a new global study published in The Lancet reveals. Researchers found that amongst SARS-CoV-2 infected patients who underwent surgery, mortality rates approach those of the sickest patients admitted to intensive care after contracting the virus in the community.

Researchers examined data for 1,128 patients from 235 hospitals. A total of 24 countries participated, predominantly in Europe, although hospitals in Africa, Asia, and North America also contributed. 

Experts at the University of Birmingham-led NIHR Global Research Health Unit on Global Surgery have now published their findings that SARS-CoV-2 infected patients who undergo surgery experience substantially worse postoperative outcomes than would be expected for similar patients who do not have SARS-CoV-2 infection.

Overall 30-day mortality in the study was 23.8%. Mortality was disproportionately high across all subgroups, including elective surgery (18.9%), emergency surgery (25.6%), minor surgery such as appendicectomy or hernia repair (16.3%), and major surgery such as hip surgery or colon cancer surgery (26.9%).

The study identified that mortality rates were higher in men (28.4%) versus women (18.2%), and in patients aged 70 years or over (33.7%) versus those aged under 70 years (13.9%). In addition to age and sex, risk factors for postoperative death included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

» Click here to read the full paper


27th March 2020

College of Surgeons Office

Dear Members,

Following the escalation of COVID-19 cases in Malaysia, healthcare services, including surgery, are under increased strain. This is reflected in the morbidity and mortality affecting the healthcare workers.

It is ESSENTIAL for adoption of a safe or cautious approach towards surgery. The guiding principles are:

  1. PROTECTION of health care workers and patients
  2. MAINTENANCE of a safe healthcare environments, including operating theatres and surgical wards
  3. CONSERVATION of resources - personnel, personal protective equipment (PPE), ventilators etc.

Based on emerging evidence, the College of Surgeons, Academy of Medicine of Malaysia (CSAMM), with its integrated Chapters, STRONGLY ADVISE members to do the following:

  1. Assume all patients are potential contacts and take adequate precautions.
  2. Postpone all non-urgent clinic appointments.
  3. Stop all elective operations and aerosol-generating procedures (AGPs, such as dental and oropharyngeal procedures, endoscopy).
  4. Use enhanced PPE if surgery/AGP in COVID-positive patients is unavoidable, minimize involved staff.
  5. Avoid laparoscopy if surgery is necessary. If laparoscopy is deemed essential, filtration devices for aerosolized particles must be used.

Other advisory measures, WHERE FEASIBLE, include:

  1. COVID-testing for all patients undergoing emergent surgery.
  2. A non-operative approach for some emergent conditions e.g. cholecystitis, appendicitis, provided the clinical status allows.
  3. CT thorax prior to emergent surgery in high-risk patients
  4. Cessation of positive pressure ventilation in OT during the procedure until 20 minutes after patient leaves.
  5. Isolation of, and full PPE when nursing, post-operative patients until COVID status known

It is IMPERATIVE that the surgical community takes leadership in flattening the curve in this pandemic, for the safety of ALL. The above measures are advised until further evidence becomes available, or until such time that the Ministry of Health declares a return to normalcy of health services.

 

Prof Dr April Camilla Roslani, President, College of Surgeons, Academy of Medicine of Malaysia
Dato’ Dr Selvalingam Sothilingam, Chair, Urology Chapter
Assoc Prof Dato’ Dr Hari Chandran Thambinayagam, Chair, Neurosurgery Chapter
Dato’ Dr Imi Sairi bin Ab Hadi, Chair, Breast and Endocrine Chapter
Prof Dr Jamal Azmi Mohamad, Chair, Orthopaedic Surgery Chapter
Dr Chew Loon Guan, Chair, Vascular Surgery Chapter
Dr Lim Yang Kwang, Chair, Maxillofacial, Aesthetic, Plastic Surgery Chapter
Prof Dr Raja Amin Raja Mokhtar, Chair, Thoracic & Cardiovascular Surgery Chapter
Dr Siow Sze Li, Chair, Upper GI Chapter
Prof Dr Tang Ing Ping, Chair, Otorhinolaryngologists - Head and Neck Surgeons Chapter
Dato’ Dr Zakaria Zahari, Chair, Paediatric Surgery Chapter
Assoc Prof Datuk Dr Ismail Sagap, Chair, Colorectal Surgery Chapter


 

References:
1. Surgical smoke and infection control. Alp E et al J Hosp Infect 2006.
2. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Kwak HD et al Occup Environ Med 2016.
3. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Repici A et al Gastrointest Endosc 2020.
4. Perioperative considerations for the 2019 Novel Coronavirus (COVID-19) Zucco L et al Anesthesia Patient Safety Foundation 2020
5. Correlation of chest CT and RT-PCR testing in Coronavirus Disease 2019 (COVID-19) in China: A report of 1014 cases. Ai T et al RSNA 2020


18 March 2020

College of Surgeons Office

The Malaysian Government has imposed a 14-day Movement Control Order from 18th to 31st March 2020 nationwide to curb the spread of Covid-19 infection in Malaysia. The office of the College will be closed during this period and the staff will be working from home. 

We would like to also announce that all CSAMM-related events until 30th June 2020 (including exams) have been postponed pending further notice in compliance with the directive from the Registrar of Societies. 

If you have any enquiry pertaining to the College matters, please email secretariat@acadmed.my

The College Council and Committees have and will continue to hold essential administrative meetings via teleconferencing. 

Thank you very much.

 

Secretariat 
College of Surgeons 
Academy of Medicine of Malaysia


18 March 2020

COLLEGE OF SURGEONS, ACADEMY OF MEDICINE OF MALAYSIA

Dear Members,

In light of the recent escalation of the COVID-19 outbreak in Malaysia, the College of Surgeons, Academy of Medicine of Malaysia (CSAMM) would like to provide the following guidance on the triage of 'non-emergent' surgical operations.

The re-deployment of staff and resources towards managing the outbreak has limited delivery of elective surgeries. Nevertheless, CSAMM is of the opinion that deferring all elective surgeries risks progression of disease states that will present further down the line with more complexity and worse outcomes.

In rationalizing the use of limited resources, the following should be considered:

1. Surgical case-mix:

Surgeries can be categorized according to the urgency of surgery as per the Perioperative Mortality Review (POMR) Guidelines: Prioritization of Cases for Emergency and Elective Surgery (2nd Revision) 2018. As an example, hospitals may choose to concentrate resources on emergencies and category one electives.

The POMR Guidelines can be accessed via the link below

» Guidelines - Perioperative Mortality Review (POMR): Prioritisation of Cases for Emergency and Elective Surgery (2nd Revision)

2. Hospital capacity:

Consideration should be given to the available resources: human resources, facilities, equipment and consumables. Designated COVID-19 hospitals may not be able to support all elective cases, in particular those that require post-operative intensive care or significant use of blood products.

3. Balance of risks:

Surgeons, in consultation with anaesthetic and nursing colleagues, should weigh the risks of proceeding (exposure, lack of resources) against those of deferment (progression of disease, worse patient outcomes). Hospital-wide policies should be fluid, and guided by emerging data.

Further guidance can be obtained from the American College of Surgeons website:

» https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage

 

Prof Dr April Camilla Roslani
President
College of Surgeons
Academy of Medicine of Malaysia


Press Release - Signing of Memorandum of Understanding (MOU)

(Last Updated: 17 Aug, 2020)