COVID-19 - ESSKA guidelines and recommendations for resuming elective surgery

Abstract

The roadmap to elective surgery resumption after this COVID-19 pandemic should be progressive and cautious. The aim of this paper was to give recommendations and guidelines for resuming elective orthopedic surgery in the safest environment possible. Elective surgery should be performed in COVID-free facilities and hospital stay should be as short as possible. For matters of safety, patients considered first for surgery should be carefully selected according to COVID infection status/exposure, age, ASA physical status classification system / risk factors, socioprofessional situation and surgical indication. A strategy for resuming elective surgery in four phases is proposed. Preoperative testing for COVID-19 infection is highly recommended. In any cases, COVID symptoms including fever and increased temperature should be constantly monitored until the day of surgery. Elective surgery should be postponed at the slightest suspicion of a COVID-19 infection. In case of surgery, adapted personal protective equipment in terms of gowns, gloves, masks and eye protection is highly recommended and described.

A look at the global impact of SARS CoV-2 on orthopedic services

“…37 Most importantly, global lockdown has placed a curb on many of the non-essential medical services, cancelling or deferring elective surgeries until the pandemic situation stabilizes in an attempt to divert healthcare infrastructure to supporting critical patient care needs. 23 …”

“… 34 One of the first guidelines released was by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), which detailed the steps towards the safe resumption of elective surgeries. 23 However, whether these guidelines prove to be applicable universally hinges on its adoption and trial by various orthopedic departments across the world. The slow return of orthopedic departments to normalcy and the compromised training of residents due to the pandemic points to an uncertain future for healthcare institutions worldwide, wherein the impact of this pandemic may yet still be felt far in the future.…”

Knowledge, attitude and perception of COVID-19 among orthopaedic surgeons

“…Hence, in the lack of proper PCR testing, fracture surgeries of potentially asymptomatic carriers maybe delayed for up to two weeks for active infectious stage to be over. 3,21,25,26 If possible, it is advisable to perform PCR before any of the AGPs. A full PPE is mandatory for dealing with suspected or PCR positive cases.…”

La traumatología deportiva ante COVID-19

“…En cuanto al postoperatorio, de ser posible utilizar vide oconferencias y/o telemedicina para minimizar visitas repetitivas y limitar el desplazamiento del paciente. 5 Respecto a las cirugías realizadas en medicina deportiva, la American Academy Orthopaedic Surgeons publicó recientemente su guía ante la pandemia COVID-19 donde hace recomendaciones de programación de cirugías electivas y el diferimiento de acuerdo a características de la patología en correlación a la fase en la que se encuentra la pandemia. 6 En México, podemos tomar como modelo esta guía y apegarla a los distintos protocolos de los sistemas de salud que se están realizando.…”