Chirurgie endocrinienne au cours et au décours de l’épidémie de COVID-19 : recommandations de l’AFCE

Baud, Grégory; Brunaud, Laurent; Lifante, Jean Christophe; Trésallet, Christophe; Sébag, F.; Bizard, J. P.; Mathonnet, Muriel; Ménégaux, Fabrice; Caïazzo, Robert; Mirallié, Éric; Pattou, François

doi:10.1016/j.jchirv.2020.04.015

Cited by 5 publications

(6 citation statements)

References 46 publications

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“…Essential cancer treatments had to continue during the pandemic. Based on national expert opinions, indications for endocrine surgery were updated and recommendations to postpone or prioritize certain procedures were made [4][5][6][7][8][9][10]. In the UK, clinical guidelines classified patients requiring surgery into four categories: emergency operations within 24 h; urgent operations within 72 h; elective procedures within 4 weeks; and surgery delayed for 10-12 weeks without adverse outcomes [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, several studies are being carried out to further understand the impact of the pandemic on the delivery of surgical services at a subspecialty level [2,3]. The World Health organization (WHO), National Health Service (NHS) in the UK, American College of Surgeons (ACS) and Royal Australasian College of Surgeons (RACS), amongst others, have published specialty-specific guidance on patient prioritization during the pandemic [4][5][6][7][8][9][10]. However, the extent of adherence to these guidelines and its impact on patient care and outcomes has not been fully reported.…”

Section: Introductionmentioning

confidence: 99%

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The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic

Kinross¹,

Beatty²,

Markar³

et al. 2021

World j. surg.

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Background In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. Methods PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11–3-2020 to 13–9-2020. Results A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. Conclusion The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic

Kinross¹,

Beatty²,

Markar³

et al. 2021

World j. surg.

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“…[46] Endoscopic vocal cord examination, which is normally recommended for preoperative evaluation before thyroid or parathyroid surgery, should not be routinely performed. 48 Vocal cord examination should be performed only in selected cases with hoarseness and appropriate personal protective equipment should be used during the examination. In the postoperative period, the laryngeal examination should only be performed on patients with recurrent laryngeal nerve injury or loss of signal during intraoperative neuromonitoring or if further contralateral surgery is planned in the near future.…”

Section: Preoperative Planning and Preparation In Covid-19 Periodmentioning

confidence: 99%

“…However, since the conditions leading to airway obstruction require urgent surgery and may result in a very high-risk intervention for aerosol propagation, such as tracheostomy, the highest protection measures should be taken in anesthesia management in such cases. [9,16,48,60] The main goal to be considered in the perioperative anesthetic management of the patient, who is diagnosed or suspected of COVID-19, is to keep the risk of contamination of the entire OR team and medical devices to a minimum without compromising patient safety. [51,57] Pre-operative Preparation: High level (Level 3) PPE is considered as the most important barrier to protect the anesthesia team during intubation and extubation stages when they are exposed to the highest level of aerosol contamination.…”

Section: Differences In Anesthesia and Preoperative Preparation (Covimentioning

confidence: 99%

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from Endocrine Surgery Society of Turkey

et al. 2020

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The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.

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“…The thyroid gland can show two main non-oncological changes that may require urgent surgery: compressive goiter with significant exacerbation of respiratory symptoms or hyperthyroidism refractory to usual drug control or with side effects to drugs (granulocytopenia, hepatitis, or allergy) (41).…”

Section: Indications For Non-cancer Surgeriesmentioning

confidence: 99%

Recommendations for head and neck surgical procedures during the COVID-19 pandemic

Kulcsar

Montenegro

Santos

et al. 2020

Clinics

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The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.

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Chirurgie endocrinienne au cours et au décours de l’épidémie de COVID-19 : recommandations de l’AFCE

Cited by 5 publications

References 46 publications

The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic

The PanSurg‐PREDICT Study: Endocrine Surgery During the COVID‐19 Pandemic

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from Endocrine Surgery Society of Turkey

Recommendations for head and neck surgical procedures during the COVID-19 pandemic

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