LAUSR

BACKGROUND The COVID-19 pandemic poses a critical global public health crisis. Operating room (OR) best practice in this crisis is poorly defined. This systematic review was performed to identify contemporary evidence relating to OR practice in the context of COVID-19. METHODS Medline was systematically searched using PubMed (search date March 19, 2020) for relevant studies in accordance with PRISMA guidelines. Documented practices and guidance were assessed to determine Oxford levels of evidence (OLE), and recommendations for practice within five domains were extracted: physical OR, personnel, patient, procedure, and other factors. RESULTS Thirty-five articles were identified, of which 11 met eligibility criteria. Nine articles constituted expert opinion and two were retrospective studies. All articles originated from the Far East (China nine, Singapore two); eight of the articles concerned general surgery. Common themes were identified within each domain, but all recommendations were based on low levels of evidence, median OLE 5 (range 4 - 5). The highest number of overlapping recommendations related to physical OR (n=8) and procedural factors (n=13). Although few recommendations related to personnel factors, consensus was high in this domain, with all studies mandating the use of personal protective equipment. CONCLUSIONS There was little evidence to inform this systematic review, but there was consensus regarding many aspects of OR practice. Within the context of a rapidly evolving pandemic, timely amalgamation of global practice and experiences is needed to inform best practice. This article is protected by copyright. All rights reserved.