How to risk-stratify elective surgery during the COVID-19 pandemic?

Stahel, Philip F.

doi:10.1186/s13037-020-00235-9

Cited by 256 publications

(278 citation statements)

References 6 publications

(7 reference statements)

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“…Until appropriate treatments and vaccines are available, limiting exposure is considered the best option for preventing further disease spread, especially among at-risk healthcare providers. Unfortunately, it is a reality that patients who are either infected or have an unknown infectious status might require emergent surgical intervention before testing results are available [6]. Strict adherence to droplet and contact isolation precautions for SARS-CoV-2 must be maintained to minimize the risk to healthcare providers.…”

Section: Resultsmentioning

confidence: 99%

Isolation protocol for a COVID-2019 patient requiring emergent surgical intervention: case presentation

et al. 2020

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Background: The concerns of the highly contagious and morbid nature of Coronavirus Disease-2019 (COVID-2019 have prompted healthcare workers to implement strict droplet and contact isolation precautions. Unfortunately, some patients who may be or presumptively or confirmed as infected with COVID-2019 may also require emergent surgical procedures. As such, given the high-risk for exposure of many healthcare workers involved the complex requirements for appropriate isolation must be adhered to. Case presentation: We present our experience with a 77-year-old who required emergency cardiac surgery for a presumed acute aortic syndrome in the setting of a presumed, and eventually confirmed, COVID-2019 infection. We outline the necessary steps to maintain strict isolation precautions to limit potential exposure to the surgical Team. Conclusions: We hereby provide our algorithm for emergent surgical procedures in critically-ill patients with presumptive or confirmed infection with COVID-2019. The insights from this case report can potentially be templated to other facilities in order to uphold high standards of infection prevention and patient safety in surgery during the current COVID-19 pandemic.

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Section: Resultsmentioning

confidence: 99%

Isolation protocol for a COVID-2019 patient requiring emergent surgical intervention: case presentation

et al. 2020

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“…This mandates the need for national and international guidelines for addressing these issues. Stahel [10] has provided an algorithm based on elective surgical indications and predicted proper perioperative utilization of critical resources, including the consideration for intra/postoperative blood product transfusions, estimated postoperative hospital length of stay, and the expected requirement for prolonged ventilation and need for postoperative ICU admission.…”

Section: Discussionmentioning

confidence: 99%

Impact of Covid-19 on General Surgical Practice in India

Nasta

Goel

Manickavasagam

et al. 2020

Preprint

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Introduction: The Coronavirus disease—2019 (COVID‐19) pandemic is a global health crisis and surgeons are at increased occupational risk of contracting COVID‐19. The impact of the disease on prevalent general surgical practice is uncertain and continues to evolve.Aims/Objectives: To study the impact of COVID-19 on general surgical practice in India and the future implications of the pandemic.Methods: A survey questionnaire was designed and electronically circulated one month after India entered a national lockdown during covid-19 pandemic, among members of Indian Association of Gastro-intestinal Endo-surgeons (IAGES), a surgical association with nearly eight thousand members. Survey questions pertaining to pre-COVID era surgical practices, impact on current practice and financial implications were asked. Responses were collected and statistically analyzed.Results: 153 surgeons completed the survey, of which only 9.2% were females. 41% surgeons were more than 20 years into practice. 36.6% were into private practice at multiple hospitals (free-lancers). 41.8% had mainly laparoscopic practice with mean outpatient consultation of 26 patients/day and elective surgeries of 43 cases /month prior to lockdown. Post lock-down, daily outpatient consults reduced to 4 patients/day and 77% had not performed even a single elective procedure. 52% were taking hydroxychloroquine (HCQ) as chemoprophylaxis. 56.9% stated they are using personal protective equipment for all cases while 71.5% stated there are insufficient guidelines for future surgical practice in terms of safety. 52% surgeons stated a drop of more than 75% of their monthly income while 22% faced 50-75% reduction. 33% of respondents own a hospital and are expecting a monthly financial liability of 2.25 Million rupees (nearly 30,000 US dollars).Conclusion: COVID 19 has led to a drastic reduction in outpatient and elective surgical practices. There is a definite need for guidelines regarding safety for future surgical practices and solutions to overcome the financial liabilities in the near future.

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“…The recommended safety precautions include the standardized use of video-assisted laryngoscopy for endotracheal intubations to attenuate the risk of aerosol exposure by increasing the distance between provider and patient during the procedure [12,13,18,19]. An additional prevalent strategy to decrease the risk of accidental viral exposure during in−/extubation is to limit surgical cases during the COVID-19 pandemic by risk-stratification to essential indications exclusively, and to take all necessary precautions in the perioperative management of urgent and emergent cases [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Introducing the “Corona Curtain”: an innovative technique to prevent airborne COVID-19 exposure during emergent intubations

Hill

Crockett²,

Circh

et al. 2020

Patient Saf Surg

Self Cite

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Background: The coronavirus disease 2019 (COVID-19) pandemic places healthcare workers at risk of exposure to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Emergency department (ED) staff are particularly vulnerable when managing patients with acute respiratory distress due to the aerosolization of the virus during endotracheal intubation. A simple and innovative intubation tent was designed with the intent of decreasing the risk of accidental viral transmission from emergent intubations during the COVID-19 pandemic. Presentation of technique: The materials and assembly process of the novel "Corona Curtain" are described in technical detail, with the intent of allowing other providers to template the concept at their respective facilities. Results: A total of 36 intubation tents were mounted in the ED at the Medical Center of Aurora, Colorado, on April 7, 2020, and thereafter consistently used for all intubations during the ongoing COVID-19 outbreak. The cost of raw materials and labor for the initial assembly averaged US $ 8.00 per construct. The price of the single-use plastic cover is variable depending on the vendor source. Conclusion: The new "Corona Curtain" was designed to improve the safety of ED staff when performing urgent/ emergent intubations during the current COVID-19 pandemic. The concept can easily be adopted to other patient care areas, including perioperative and intensive care units. Future validation studies are needed to determine the safety and efficacy of the intubation tents by quantifying the pre−/post-intubation exposure through "point-of-care" SARS-CoV-2 testing once these resources are more widely available.

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How to risk-stratify elective surgery during the COVID-19 pandemic?

Cited by 256 publications

References 6 publications

Isolation protocol for a COVID-2019 patient requiring emergent surgical intervention: case presentation

Isolation protocol for a COVID-2019 patient requiring emergent surgical intervention: case presentation

Impact of Covid-19 on General Surgical Practice in India

Introducing the “Corona Curtain”: an innovative technique to prevent airborne COVID-19 exposure during emergent intubations

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