Manejo quirúrgico de pacientes con infección por COVID-19. Recomendaciones de la Asociación Española de Cirujanos

Balibrea, José María; Badía, Josep M.; Pérez, Inés Rubio; Antona, Esteban Martín; Peña, Estíbaliz Álvarez; Botella, Sandra García; Gallego, Mario Álvarez; Pérez, Elena Martín; Cortijo, Sagrario Martínez; Migueláñez, Isabel Pascual; Díaz, Lola Pérez; Rodríguez, José Luis Ramos; Basany, Eloy Espín; Santos, Raquel Sánchez; Soria-Aledo, Víctor; Barrachina, Ruth López; Morales-Conde, Salvador

doi:10.1016/j.ciresp.2020.03.001

Cited by 118 publications

(133 citation statements)

References 17 publications

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“…The standard preoperative laboratory workup should include a full blood count to identify COVID-19-related alterations such as leukocytopenia and lymphopenia as well as coagulation tests, kidney-liver function and CRP levels, as well as blood sugar levels to exclude diabetes [40,42,47,49,50,52,57,58].…”

Section: Pre-anesthetic Processmentioning

confidence: 99%

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

Kaye¹,

Paprottka²,

Escudero³

et al. 2020

Aesth Plast Surg

138

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Background The worldwide spread of a novel coronavirus disease has led to a near total stop of nonurgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the selfimposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/ procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. Methods We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of crosscontamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. Conclusion The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a riskminimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare

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Section: Pre-anesthetic Processmentioning

confidence: 99%

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

Kaye¹,

Paprottka²,

Escudero³

et al. 2020

Aesth Plast Surg

138

View full text Add to dashboard Cite

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“…1,[3][4][5][6] ATENCIÓN DE PACIENTES POSTOPERADOS Incluye los pacientes operados seis meses previos al brote de COVID-19, para ellos hay que reducir el acceso a servicios de emergencia, posponer consultas no urgentes o hacer uso de la telemedicina. 1,3,[6][7][8] En todos los padecimientos ortopédicos que requieren atención ambulatoria o consulta se debe revisar un paciente a la vez, llevando a cabo todo el protocolo de sanitización del espacio entre cada paciente y dejar espacio para los pacientes postoperados. También se debe proponer la opción de realizar telemedicina o reprogramar la consulta.…”

Section: Wwwmedigraphicorgmxunclassified

“…Se deben priorizar pacientes con alta www.medigraphic.org.mx discapacidad y ausencia de comorbilidad (evitar que requieran terapia intensiva). 1,[3][4][5][7][8][9] Por lo cual, los pacientes que ya tenían una cirugía programada, se debe valorar su suspensión, salvo la oncológica, o aquélla que si demora dejará secuelas. En la atención quirúrgica se debe preferir la anestesia regional en vez de la general, si es necesario llevar a cabo ésta, se debe considerar la intubación de secuencia rápida sin ventilación del paciente para evitar la aerolización y dispersión del virus en la sala de operaciones; se prefiere el uso de quirófanos con presión negativa neutra, evitar el uso de escafandras con recirculación de aire; además de tener en cuenta e informar al paciente que existe un aumento de hasta 20% de mortalidad en pacientes portadores de COVID al realizar su cirugía electiva.…”

Section: Programación De Cirugía Electivaunclassified

El cirujano de pie y tobillo y su rol en la era del COVID 19

Villar¹,

Mendoza²

2020

Ortho-Tips

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“…Nonetheless, we can share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and the strategies we have implemented. We think this is important because, despite guidance via expert opinions [6][7][8][9][10] , no published outcome experiences are based on the strategies applied. Furthermore, that guides do not explain how orthopaedic and trauma staff can help and be part of the solution of this outbreak.…”

Section: Introductionmentioning

confidence: 99%

Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience

Núñez

Porcel

Pijoan

et al. 2020

Injury

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Introduction: The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. Methods: Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. Results: Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. Conclusions: As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures.

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Manejo quirúrgico de pacientes con infección por COVID-19. Recomendaciones de la Asociación Española de Cirujanos

Cited by 118 publications

References 17 publications

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

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

El cirujano de pie y tobillo y su rol en la era del COVID 19

Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience

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