'Overnight, things changed. Suddenly, we were in it': a qualitative study exploring how surgical teams mitigated risks of COVID-19

BMJ Open. 2021 Jun 16;11(6):e046662. doi: 10.1136/bmjopen-2020-046662.


Objectives: COVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk.

Design: In-depth, semistructured interviews were audio recorded, transcribed and analysed thematically using methods of constant comparison.

Participants: 43 participants, including surgeons from a range of specialties (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles.

Setting: The UK, Italy, Spain, the USA, China and New Zealand between March and May 2020.

Results: Surgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients while contemplating their own safety.

Conclusions: The perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence-based practice resulting from a pragmatic and novel approach to collation of global evidence. The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.

Keywords: COVID-19; qualitative research; surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • China
  • Humans
  • Italy
  • New Zealand
  • Pandemics*
  • Risk Management*
  • SARS-CoV-2
  • Spain
  • Surgical Procedures, Operative*