Informed consent and a risk‐based approach to oncologic surgery in a cancer center during the COVID‐19 pandemic

Zéqui, Stênio de Cássio; Silva, Ivan Leonardo Avelino Franca; Duprat, João Pedreira; Coimbra, Felipe José Fernández; Gross, Jefferson Luiz; Vartanian, José Guilherme; Makdissi, Fabiana Baroni Alves; Leite, Fernanda; Costa, Walter Henriques da; Yazbek, Guilherme; Joaquim, Eduardo Henrique Giroud; Bussolotti, Raquel Marcondes; Caruso, Pedro; Lima, Marcon Censoni de Ávila; Nakagawa, Suely Akiko; Aguiar, Samuel; Baiocchi, Glauco; Lopes, Ademar; Kowalski, Luiz Paulo

doi:10.1002/jso.26452

Cited by 3 publications

(4 citation statements)

References 40 publications

(147 reference statements)

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“…In the paediatric cohort, there is limited data but a minimum 28-day delay has been suggested for asymptomatic patients positive for SARS-CoV-2 in a paediatric cohort [36]. In patients undergoing cancer surgery, a 3-week wait has been recommended [37]. The waiting time for patients who are symptomatic for COVID-19 (with or without a positive test) should naturally be guided by the clinical course of the disease and the indication of surgery.…”

Section: Management Patients With Positive Testsmentioning

confidence: 99%

“…This should form a standard part of all consent during the pandemic. There have been attempts to develop a comprehensive informed consent for use during the pandemic including information on unexpected absence or replacement of staff, risk of perioperative SARS-CoV-2 patients and other unexpected occurrences that cannot be discussed in advance [37].…”

Section: Consent For Surgerymentioning

confidence: 99%

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Safe Surgery During the COVID-19 Pandemic

et al. 2021

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Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

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Section: Management Patients With Positive Testsmentioning

confidence: 99%

Section: Consent For Surgerymentioning

confidence: 99%

Safe Surgery During the COVID-19 Pandemic

et al. 2021

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“…Moreover, among both the public and medical communities, the ethical issues raised by this triage approach have undermined confidence in, and adherence to, decisions taken by health authorities and politicians. 12,13 This situation warrants an urgent reassessment of the governance structure driving decision-making for oncological treatment and surgical prioritization in times of crisis, especially in light of the potential for new COVID-19 variants and future health system shocks. Here, we offer specific suggestions to improve this process, learning from insights gained during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prioritization of Surgery in Cancer Patients During the COVID-19 Pandemic

Donckier

Estache

Liberale

et al. 2021

Annals of Surgery Open

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The prioritization of surgical oncology over other elective interventions during COVID-19 has failed to preserve the quality of care in oncology and will likely lead to an increase of cancer-related mortality in the coming years. We propose five components for systems to improve the organization of surgical oncology during future crises, namely (1) a multidisciplinary governance structure employing predictive models and risk/benefit evaluations, (2) predefined quality objectives based on measurable markers (regularly reviewed and adapted), (3) temporary flexibility in therapeutic algorithms and authorization procedures (with associated safeguards), (4) systems to ensure access to transparent, apolitical information, and (5) explicit, dedicated logistical surgical capacities to optimize coordination and resource allocation.

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