COVID-19: Pandemic surgery guidance

Abstract

Based on high quality surgery and scientific data, scientists and surgeons are committed to protecting patients as well as healthcare staff and hereby provide this Guidance to address the special issues circumstances related to the exponential spread of the Coronavirus disease 2019 (COVID-19) during this pandemic. As a basis, the authors used the British Intercollegiate General Surgery Guidance as well as recommendations from the USA, Asia, and Italy. The aim is to take responsibility and to provide guidance for surgery during the COVID-19 crisis in a simplified way addressing the practice of surgery, healthcare staff and patient safety and care. It is the responsibility of scientists and the surgical team to specify what is needed for the protection of patients and the affiliated healthcare team. During crises, such as the COVID-19 pandemic, the responsibility and duty to provide the necessary resources such as filters, Personal Protective Equipment (PPE) consisting of gloves, fluid resistant (Type IIR) surgical face masks (FRSM), filtering face pieces, class 3 (FFP3 masks), face shields and gowns (plastic ponchos), is typically left up to the hospital administration and government. Various scientists and clinicians from disparate specialties provided a Pandemic Surgery Guidance for surgical procedures by distinct surgical disciplines such as numerous cancer surgery disciplines, cardiothoracic surgery, ENT, eye, dermatology, emergency, endocrine surgery, general surgery, gynecology, neurosurgery, orthopedics, pediatric surgery, reconstructive and plastic surgery, surgical critical care, transplantation surgery, trauma surgery and urology, performing different surgeries, as well as laparoscopy, thoracoscopy and endoscopy. Any suggestions and corrections from colleagues will be very welcome as we are all involved and locked in a rapidly evolving process on increasing COVID-19 knowledge.

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

“…Another patient series published by Li et al from thoracic surgery department also suggests the association of higher age and chronic obstructive pulmonary disease (COPD) with disease severity (P = 0.041 and P = 0.040, respectively) and death (P = 0.015 and P = 0.038, respectively) for COVID-19 patients. In this study, five deaths (20%) among hospitalized postoperative patients were reported, leading to the conclusion that patients infected with COVID-19 in the perioperative period have a higher risk of death [7].…”

Changes in Emergency General Surgery During Covid‐19 in Scotland: A Prospective Cohort Study

“…In addition, many aspects of surgery are considered to be aerosol generating, and therefore, health care workers are at potential risk should necessary precautions not be taken [8]. In response to this, the United Kingdom Intercollegiate guidance was published in late March and outlined recommendations for provision of surgery [9]. It concluded that laparoscopic surgery, given its potential for aerosol generation, should be considered only in selected individuals where clinical benefit exceeds the potential risk of viral transmission.…”

Consensus on peri-operative surgical practice during the COVID-19 pandemic: an appraisal of the literature

“…Measures such as risk assessment and serology testing of members of the teams working in the OR should be done [20]. Additionally, surgical sections should be ideally divided into two categories, a dedicated section for positive patients which only needs minimum OR and surgical staff and another section dedicated for emergency surgery and urgent oncological surgery and depending on the risk assessment, for other routine surgeries in COVID-19 negative patients [21].…”