Excellence Strategy

Project results by Annika Henner and Iaroslav Sautkin

Annika Henner (General Rhetoric) and Iaroslav Sautkin (PhD Program in Experimental Medicine) have addressed issues of decision-making and scheduling of procedures in planned (elective) surgery. Their graphics summarize basic aspects and suggestions for action:

Background on the creation process

Our first idea was not just to visualize defined results from the CovidSurg Collaborative, but to pick a general aspect of their studies that applies directly to the current situation in Western countries. Browsing published work from CovidSurg, especially their study concerning the ideal time to perform surgical interventions on patients after SARS-CoV-2 infection, got us interested in planned (elective) surgery in this context. As surgery is associated with significantly higher mortality and complication rates in infected patients since the beginning of the coronavirus pandemic, there is a need for more careful and risk-based preoperative decision-making. We therefore studied the results of a study published in the scientific journal Anaesthesia and chose to create a simplified overview for medical laymen and women, including important risk factors currently connected with planned (elective) surgery.

The main focus of our graphics is giving patients who are about to undergo planned (elective) surgery an overview about the factors that should be considered when facing the decision whether and when to undergo surgery during the coronavirus pandemic.

The key message is to schedule the optimal date for elective surgery during the current global crisis based on an adequate risk-benefit assessment. Every intervention as well as every patient´s personal risks and expected benefits are individual and need discussing with the  treating surgeons. As a result, an informed and well-considered decision on elective surgery may lead to better outcomes, including lower mortality and morbidity rates.

The factors that need to be considered are manifold – among other aspects whether the patients are already vaccinated as well as their own medical conditions and history. After infection with SARS-CoV-2, if possible they should (as a general advice) wait at least seven weeks and be free of COVID-symptoms at surgery to reduce the risks for complications.

Since our target group is everyone who is about to have planned surgery, we wanted the style of our graphics to be accessible and inviting. We decided to present our material via a comic-like visualization and chose colors that aim to create a modern and appealing look. Getting feedback from other participants of the seminar, we jointly figured out aspects that would improve the accessibility of the information and adapted our work accordingly. Among other things, we reconsidered the symmetry of our graphics and the visualization of data in the included chart. We also received support from Prof. Brittany Bankhead-Kendall, one of the US-American leads of the CovidSurg Collaborative, who gave us some helpful advice on our graphics and new ideas as well as a context to the whole project in general.

Our illustrations might be used in waiting rooms of doctors‘ offices or hospitals‘ as a poster so patients who are considering elective surgery can familiarize themselves with what to address in discussions with their treating surgeons.

© Annika Henner
This illustration aims to provide basic information concerning the optimal scheduling of planned (elective) surgery after an infection with the coronavirus SARS-CoV-2. According to results from a worldwide study conducted by the COVIDSurg Collaborative, the risks connected with surgery increase substantially following SARS-CoV-2 infection, leading to temporarily higher mortality and complication rates. It is important to note that the majority of patients in this study was asymptomatic at the time of surgery but showed medical problems afterwards. Patients should therefore wait at least seven weeks after a positive SARS-CoV-2 test and be completely free of any COVID-symptoms before undergoing elective surgery, if possible. The bar chart added on the left shows the adjusted 30-day-mortality rates for planned surgical interventions in patients operated after a SARS-CoV-2 infection and differentiates between different intervals after diagnosis. (For details and background see: Anaesthesia, 76(6), 748-758; Figure 1).
© Iaroslav Sautkin
This visualisation aims to support people to decide on planned (elective) surgery. Based on the data published by the COVIDSurg Collaborative, there are increased mortality and complications associated with surgery during the COVID-19 pandemic among infected patients. Since the time of planned surgery can be flexibly chosen, there is a possibility to pick a suitable date to minimise possible risks. However, such a decision can be difficult and should be taken in conformity with the treating physician. Specific risks associated with COVID-19 should be considered and possibly eliminated. The visualisation illustrates the underlying considerations in several steps. The main point offers a list of questions to discuss between patient and physician. As a result, the schedule of surgery dates can be adapted and the risks potentially mitigated.