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During the last three months, COVID-19 pandemic had led to a serious backlog of operations globally, and plans for restarting operation are imperative1–3. Recommendations for surgical activities were studied, aiming to protect the surgical staff from being infected4,5. In the meantime, it is also important to give attention to the surgeon's personal feeling during work. We conducted

Table 1

Univariate and multivariate analysis on factors associated with surgeon's fear (Total N = 1124)

   UnivariateMultivariate
Factors Feara, n (%)ORP valueOR95%CIP value
High risk countryYes273 (64·8)1·2640·0671·0550·781-1·4240·729
 No416 (59·3)Ref.    
Gloves easily getYes647 (60·8)0·5910·0770·650·334-1·2640·204
 No42 (72·4)Ref.    
Gowns easily getYes413 (59·5)0·8090·0961·070·806-1·4210·64
 No276 (64·5)Ref.    
Eye-protector easily getYes289 (60·8)0·9590·739   
 No500 (61·8)Ref.    
Surgical mask easily getYes520 (58·3)0·505<0·0010·6230·435-0·8930·01 
 No169 (73·5)Ref.    
FFP2/N95 easily getYes166 (62·6)1·0710·637   
 No523 (61·0)Ref.    
Hand sanitizer easily getYes596 (60·9)0·8370·34   
 No93 (65·0)Ref.    
Satisfaction to hospital measuresYes325 (53·2)0·439<0·001 0·4640·355-0·606<0·001
 No339 (72·1)Ref.    
COVID-19 caseload in hospital>10290 (60·2)1·0810·544   
 <10306 (58·3)Ref.    
Performing surgery with PPEYes256 (64·6)1·2370·1   
 No433 (59·6)Ref.    
Testing everyone before surgeryYes119 (57·5)0·8180·199   
 No570 (62·3)Ref.    
No guideline availableNo142 (68·6)1·470·0191·3410·951-1·8920·094
 Guideline available547 (59·8)Ref.    
Routine chest CT before surgeryYes161 (58·5)0·8530·262   
 No528 (62·3)Ref.    
Experience of asymptomatic patientsYes200 (69·4)1·6030·0011·3110·925-1·8590·128
 No489 (58·6)Ref.    
Experience of in-hospital infectionsYes259 (67·8)1·5180·0021·4571·052-2·0180·024
 No430 (58·1)Ref.    
Staff get universal testYes21 (61·8)1·0160·965   
 No668 (61·4)Ref.    
Staff get infectedYes249 (67·1)1·4430·0061·2030·881-1·6430·246
 No440 (58·6)Ref.    
   UnivariateMultivariate
Factors Feara, n (%)ORP valueOR95%CIP value
High risk countryYes273 (64·8)1·2640·0671·0550·781-1·4240·729
 No416 (59·3)Ref.    
Gloves easily getYes647 (60·8)0·5910·0770·650·334-1·2640·204
 No42 (72·4)Ref.    
Gowns easily getYes413 (59·5)0·8090·0961·070·806-1·4210·64
 No276 (64·5)Ref.    
Eye-protector easily getYes289 (60·8)0·9590·739   
 No500 (61·8)Ref.    
Surgical mask easily getYes520 (58·3)0·505<0·0010·6230·435-0·8930·01 
 No169 (73·5)Ref.    
FFP2/N95 easily getYes166 (62·6)1·0710·637   
 No523 (61·0)Ref.    
Hand sanitizer easily getYes596 (60·9)0·8370·34   
 No93 (65·0)Ref.    
Satisfaction to hospital measuresYes325 (53·2)0·439<0·001 0·4640·355-0·606<0·001
 No339 (72·1)Ref.    
COVID-19 caseload in hospital>10290 (60·2)1·0810·544   
 <10306 (58·3)Ref.    
Performing surgery with PPEYes256 (64·6)1·2370·1   
 No433 (59·6)Ref.    
Testing everyone before surgeryYes119 (57·5)0·8180·199   
 No570 (62·3)Ref.    
No guideline availableNo142 (68·6)1·470·0191·3410·951-1·8920·094
 Guideline available547 (59·8)Ref.    
Routine chest CT before surgeryYes161 (58·5)0·8530·262   
 No528 (62·3)Ref.    
Experience of asymptomatic patientsYes200 (69·4)1·6030·0011·3110·925-1·8590·128
 No489 (58·6)Ref.    
Experience of in-hospital infectionsYes259 (67·8)1·5180·0021·4571·052-2·0180·024
 No430 (58·1)Ref.    
Staff get universal testYes21 (61·8)1·0160·965   
 No668 (61·4)Ref.    
Staff get infectedYes249 (67·1)1·4430·0061·2030·881-1·6430·246
 No440 (58·6)Ref.    

aNumber of surgeons with fear: N = 689 (61·3%) OR, odds ratio, Ref, Reference, PPE, personal protective equipment, CT, computed tomography.

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Table 1

Univariate and multivariate analysis on factors associated with surgeon's fear (Total N = 1124)

   UnivariateMultivariate
Factors Feara, n (%)ORP valueOR95%CIP value
High risk countryYes273 (64·8)1·2640·0671·0550·781-1·4240·729
 No416 (59·3)Ref.    
Gloves easily getYes647 (60·8)0·5910·0770·650·334-1·2640·204
 No42 (72·4)Ref.    
Gowns easily getYes413 (59·5)0·8090·0961·070·806-1·4210·64
 No276 (64·5)Ref.    
Eye-protector easily getYes289 (60·8)0·9590·739   
 No500 (61·8)Ref.    
Surgical mask easily getYes520 (58·3)0·505<0·0010·6230·435-0·8930·01 
 No169 (73·5)Ref.    
FFP2/N95 easily getYes166 (62·6)1·0710·637   
 No523 (61·0)Ref.    
Hand sanitizer easily getYes596 (60·9)0·8370·34   
 No93 (65·0)Ref.    
Satisfaction to hospital measuresYes325 (53·2)0·439<0·001 0·4640·355-0·606<0·001
 No339 (72·1)Ref.    
COVID-19 caseload in hospital>10290 (60·2)1·0810·544   
 <10306 (58·3)Ref.    
Performing surgery with PPEYes256 (64·6)1·2370·1   
 No433 (59·6)Ref.    
Testing everyone before surgeryYes119 (57·5)0·8180·199   
 No570 (62·3)Ref.    
No guideline availableNo142 (68·6)1·470·0191·3410·951-1·8920·094
 Guideline available547 (59·8)Ref.    
Routine chest CT before surgeryYes161 (58·5)0·8530·262   
 No528 (62·3)Ref.    
Experience of asymptomatic patientsYes200 (69·4)1·6030·0011·3110·925-1·8590·128
 No489 (58·6)Ref.    
Experience of in-hospital infectionsYes259 (67·8)1·5180·0021·4571·052-2·0180·024
 No430 (58·1)Ref.    
Staff get universal testYes21 (61·8)1·0160·965   
 No668 (61·4)Ref.    
Staff get infectedYes249 (67·1)1·4430·0061·2030·881-1·6430·246
 No440 (58·6)Ref.    
   UnivariateMultivariate
Factors Feara, n (%)ORP valueOR95%CIP value
High risk countryYes273 (64·8)1·2640·0671·0550·781-1·4240·729
 No416 (59·3)Ref.    
Gloves easily getYes647 (60·8)0·5910·0770·650·334-1·2640·204
 No42 (72·4)Ref.    
Gowns easily getYes413 (59·5)0·8090·0961·070·806-1·4210·64
 No276 (64·5)Ref.    
Eye-protector easily getYes289 (60·8)0·9590·739   
 No500 (61·8)Ref.    
Surgical mask easily getYes520 (58·3)0·505<0·0010·6230·435-0·8930·01 
 No169 (73·5)Ref.    
FFP2/N95 easily getYes166 (62·6)1·0710·637   
 No523 (61·0)Ref.    
Hand sanitizer easily getYes596 (60·9)0·8370·34   
 No93 (65·0)Ref.    
Satisfaction to hospital measuresYes325 (53·2)0·439<0·001 0·4640·355-0·606<0·001
 No339 (72·1)Ref.    
COVID-19 caseload in hospital>10290 (60·2)1·0810·544   
 <10306 (58·3)Ref.    
Performing surgery with PPEYes256 (64·6)1·2370·1   
 No433 (59·6)Ref.    
Testing everyone before surgeryYes119 (57·5)0·8180·199   
 No570 (62·3)Ref.    
No guideline availableNo142 (68·6)1·470·0191·3410·951-1·8920·094
 Guideline available547 (59·8)Ref.    
Routine chest CT before surgeryYes161 (58·5)0·8530·262   
 No528 (62·3)Ref.    
Experience of asymptomatic patientsYes200 (69·4)1·6030·0011·3110·925-1·8590·128
 No489 (58·6)Ref.    
Experience of in-hospital infectionsYes259 (67·8)1·5180·0021·4571·052-2·0180·024
 No430 (58·1)Ref.    
Staff get universal testYes21 (61·8)1·0160·965   
 No668 (61·4)Ref.    
Staff get infectedYes249 (67·1)1·4430·0061·2030·881-1·6430·246
 No440 (58·6)Ref.    

aNumber of surgeons with fear: N = 689 (61·3%) OR, odds ratio, Ref, Reference, PPE, personal protective equipment, CT, computed tomography.

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a survey to investigate global surgical practices during the COVID-19 pandemic6, and the surgeon's personal feeling was also investigated in the survey. In this special letter, we performed multivariate analysis to explore factors that associated with surgeon's fear of getting infected by COVID-19.

In total, 1124 surgeons from 936 centers in 71 countries replied to the questions. Regarding surgeon's satisfaction towards hospital's preventive measures, 612 of the respondents (54·4%) agreed that their centers were taking enough preventive measures to avoid in-hospital transmission. With respect to the results by nations, respondents from the UK reported lowest satisfaction (6/27, 22·2%), while those from China (70/73, 95·9%) and the Netherland (26/33, 78·8%) reported higher satisfaction. When asked about the personal fear of getting sick or infecting others (1 point = never, 5 points = always), the respondents in overall reported a relatively high score (the mean ± SD of all respondents: 3·7 ± 1·3). The respondents from Mexico (4·7 ± 0·6, n = 31), the US (4·2 ± 1·2, n = 51) and Turkey (4·2 ± 1·0, n = 38) had higher scores, while those from the Netherlands (2·5 ± 1·2, n = 33) and China (2·6 ± 1·4, n = 73) had lower scores.

In order to explore factors that were associated with surgeon's fear of getting infected, univariate and multivariate analysis were performed using the data from the entire survey (including content about COVID-19 testing policies, protective measures and COVID-19 caseload) (Table 1). Surgeons with personal fear were defined as those with 4 or 5 points in the question “Have you ever been afraid of getting sick or infecting others because of your work?”. The factors with P values < 0·1 in the univariate analysis were high risk country (P = 0·067), shortage of gloves (P = 0·077), shortage of gowns (P = 0·096), shortage of surgical masks (P < 0·001), satisfaction to hospital's measures (P < 0·001), available guideline (P = 0·019), episodes with asymptomatic patients in surgical settings (P = 0·001), experiencing in-hospital infections (P = 0·002), and staff infections (P = 0·006). The multivariate analysis of these parameters revealed that shortage of surgical masks (OR: 1·605, 95%CI: 1·120-2·299, P = 0·01), unsatisfaction towards hospital's preventive measures (OR: 2·155, 95%CI: 1·650-2·813, P < 0·001) and experiencing in-hospital infections (OR: 1·457, 95%CI: 1·052-2·018, P = 0·024) were independently associated with surgeon's fear of getting infected. It is noteworthy that high caseload (>10 cases) of COVID-19 in the centers (P = 0·544 in univariate analysis) and countries' pandemic status of high risk (P = 0·729 in multivariate analysis) were not related to surgeon's fear. (High risk countries are defined as the ones with death case number of COVID-19 being more than 5000 on 8th April.)

This survey clarified the current surgeons' fear of getting infected due to their work, and the fear was particularly associated with surgical mask shortage and experiencing in-hospital infections. Since the propagation of the virus is subsiding, many hospitals are currently restarting elective surgeries. With increasing surgeons' workload, the social support for the surgeons' fear and securing working environment with enough PPE supply are warranted.

Acknowledgement

We would like to thank all the collaborators of “S-COVID Collaborative Group”6 for contribution to the study; the surgical societies (European Society of Surgical Oncology, Latin American Society of Surgical Oncology, Russian Society of Colorectal Surgeons and Società Italiana di Chirurgia Colo-Rettale) for distributing the survey.

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Author notes

Yongbo An, Vittoria Bellato and Tsuyoshi Konishi contributed equally to this work as the co-first authors.

© 2020 BJS Society Ltd. Published by John Wiley & Sons, Ltd.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Subject
General Surgery
Issue Section:
Correspondence
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