A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into eight domains: (1) General recommendation for surgical services; (2) Emergency Surgery for critically ill COVID-19 positive or suspected patients -Preoperative planning and case selection; (3) Operating Room setup; (4) patient transport to the OR; (5) Surgical staff preparation; (6) Anesthesia considerations; (7) Surgical approach; and (8) Case Completion.The European Society of Emergency Surgery board endorsed these recommendations.

The consequences of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have been devastating to the healthcare system.As the positive effects of social distancing, mandatory masking, and societal lockdown on the spread of the disease and its incidence in the community were documented, societal and financial pressures mounted worldwide, prompting efforts to “re-open” countries, states, communities, businesses, and schools. The same happened with hospital, which had to start developing strategies to resume elective surgery activities. This manuscript describes the pre-requisites as well as the strategies for resuming surgical activity, be it in the outpatient or inpatient setting.

Background The best surgical approach to treat acute cholecystitis (AC) in cirrhotic patients is controversial. This study aimed to evaluate treatment options in cirrhotic patients with AC. We hypothesized that laparoscopic cholecystectomy (LC) would lead to better clinical outcomes when compared to non‐operative management (NOM) and open cholecystectomy (OC), independent of the severity of liver cirrhosis. Methods Patients from the National Inpatient Sample diagnosed with AC were stratified into no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC) and analyzed according to treatment: NOM, OC, and LC. Primary outcome was in‐hospital mortality. Secondary outcomes included hospital length of stay (HLOS), cost, and surgical complications. Univariate and multivariate analyses using generalized linear models were performed. A P < 0.05 was deemed significant. Results Of 1 367 495 AC patients, 49 030 (3.6%) had cirrhosis; 23 260 had CC, and 25 770 had DC. LC (12 080 in CC group and 4840 in DC group) was accompanied by significantly lower mortality, HLOS, complications, and cost when compared to OC and NOM. OC was significantly associated with higher mortality, increased HLOS, total cost, and postoperative complications, independent of the presence or severity of cirrhosis. Conclusions LC in cirrhotic patients leads to superior outcomes compared to OC and NOM regardless of the severity of cirrhosis.

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