An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country

Idhrees, Mohammed; Padmanabhan, Chandrasekar; Jagadeesan, Kuppan; Velayudhan, Bashi

PURPOSE: There is a paucity of evidence and guidelines to support clinical decisions in the present unprecedented time. We aimed to use the experience and consensus of the cardiac surgeons for clinical decisions until evidence-based guidelines are formed. METHODS: An electronic questionnaire was emailed to all the 1434 members of the Indian Association of Cardiovascular and Thoracic Surgery, starting from May 13, 2020, and the members were followed up with reminder emails. For a wider reach, social media like WhatsApp was also used to circulate the questionnaire. Participation was voluntary and anonymized. An effective consensus was considered when > 70% opted the same opinion, and moderate consensus when > 50% opted the same opinion. RESULTS: A total of 174 responses were obtained from the surgeons across the country. An effective consensus was obtained for the following: (i) emergency surgery in acute type A aortic dissection, (ii) urgent surgery in significant left main stem disease and mitral/aortic valves with pulmonary oedema, (iii) elective surgery in stable triple vessel disease and (iv) preoperative nasal swab examination for all patients undergoing surgery. CONCLUSION: In the present era, where evidence is evolving and the country is entering a phase after lockdown, the surgeons face a dilemma in operating patients. These consensuses provide interim recommendation; still further evidence is published.