CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic

Abstract

Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

“…Healthcare workers are more susceptible to COVID-19 transmission during head and neck surgical procedures because of aerosolization of virus particles from the nasal mucosa and mouth cavity [ 18 ]. Therefore, patients with facial fractures have distinct difficulties owing to the wide range of injuries and the need to take precautions against infection.…”

“…Home drain removal successfully implemented for most neck surgeries, preventing hazardous in-person encounters while telemedicine managed rhinology cases effectively. [18,19,38,[69][70][71] Plastic…”

Risk of SARS-CoV-2 contagion in otolaryngology specialists

“…The Canadian Society of Otolaryngology Head and Neck Surgery developed guidelines defining the level of protection for healthcare workers based on specific parameters. These include Level 1 PPE: Surgical mask + gown + gloves + eye protection; Level 2 PPE: N95 respirator + fluid repellent gown + head cover including neck protection + double gloves + eye protection; and Level 3 PPE: Negative pressure room with minimum staff + N95 mask with second surgical mask + face shield or goggles + double fluid repellent gown + head cover including neck protection + double gloves 34 , 35 .…”

Pediatric Coronavirus Disease 2019: Clinical Features and Management

“…A COVID positive status during surgery may pose a risk for infection spread and portend poor surgical outcome [24]. Therefore, elective surgeries should be delayed until patients test negative for COVID-19 [25,26].…”