COVID-19: clinical issues from the Japan Surgical Society

Abstract

In this unprecedented COVID-19 pandemic, several key issues must be addressed to ensure safe treatment and prevent rapid spread of the virus and a consequential medical crisis. Careful evaluation of a patient's condition is crucial for deciding the triage plan, based on the status of the disease and comorbidities. As functionality of the medical care system is greatly affected by the environmental situation, the treatment may differ according to the medical and infectious disease circumstances of the institution. Importantly, all medical staff must prevent nosocomial COVID-19 by minimizing the effects of aerosol spread and developing diagnostic and surgical procedures. Polymerase chain reaction (PCR) screening for COVID-19 infection, particularly in asymptomatic patients, should be encouraged as these patients are prone to postoperative respiratory failure. In this article, the Japan Surgical Society addresses the general principles of surgical treatment in relation to COVID-19 infection and advocates preventive measures against viral transmission during this unimaginable COVID-19 pandemic.

The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study

“…The governor of Kyoto Prefecture declared a state of emergency on April 17, 2020 and urged residents to stay home unless necessary, until the state of emergency was lifted on May 21, 2020. Facing this unprecedented global pandemic, surgical societies and gastroenterological endoscopy societies addressed the general principles of surgical or endoscopic treatments in relation to COVID-19 infection [ [4] , [5] , [6] , [7] ]. The use of appropriate triage was recommended, and clinicians were urged to consider the postponement or cancellation of gastrointestinal endoscopies or alternative therapeutic approaches such as neoadjuvant chemotherapy or chemoradiation instead of surgery, if possible, for the prevention of nosocomial infections that could result in the breakdown of medical care.…”

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volume in Japan: A Cohort Study Using Administrative Data

“…Both surgeries have a high priority and are basically recommended to be performed without delay. 5,9,22 Second, within cardiovascular surgery types, only other types of surgery obviously decreased. During the COVID-19 pandemic, management of ICU beds and ventilators is important.…”

“…16 We also identified the type of surgery from the main surgery during admission. Categorisation was based on the major surgical areas and previous reports 5,9 preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted November 20, 2020. ; https://doi.org/10.1101/2020.11.18.20233882 doi: medRxiv preprint surgery defined as the top three most common surgeries in Japan based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), which covers the medical claim information of the entire Japanese population of 127 million. 17 Details of surgical classification are shown by K codes, which are the claims codes for surgery, in supplemental Table 1.…”

“…[2][3][4] To minimise exposure to COVID-19 and save medical resources to prevent harmful outcomes for patients, cancellation or triage of surgeries are recommended. [3][4][5] Patients with critical disease and cancers should still receive surgery as usual, whereas cases with benign diseases can be postponed. [6][7][8] Previous studies suggest that there are wide variations of trends in the affected number of surgical procedures depending on the country and time period.…”

Recommendations for the management of breast cancer patients during the COVID-19 pandemic from the Japan Breast Cancer Society

“…To minimize the use of operating room resources, we must consider the time required for recovery and how to reduce the risk of complications. Patients should be triaged for initial alternative therapies such as primary systematic therapy whenever possible [ 8 ]. Therefore, it becomes very important to define patients who require more urgent care and patients whose care can be deferred until the pandemic is over [Fig.…”