Surgical Infection Society Guidance for Restoration of Surgical Services during the Coronavirus Disease-2019 Pandemic

Abstract

Background: As the coronavirus disease-2019 (COVID-19) pandemic continues globally, high numbers of new infections are developing nationwide, particularly in the U.S. Midwest and along both the Atlantic and Pacific coasts. The need to accommodate growing numbers of hospitalized patients has led facilities in affected areas to suspend anew or curtail normal hospital activities, including elective surgery, even as earlier-affected areas normalized surgical services. Backlogged surgical cases now number in the tens of millions globally. Facilities will be hard-pressed to address these backlogs, even absent the recrudescence of COVID-19. This document provides guidance for the safe and effective resumption of surgical services as circumstances permit. Methods: Review and synthesis of pertinent international peer-reviewed literature, with integration of expert opinion. Results: The ''second-wave'' of serious infections is placing the healthcare system under renewed stress. Surgical teams likely will encounter persons harboring the virus, whether symptomatic or not. Continued vigilance and protection of patients and staff remain paramount. Reviewed are the impact of COVID-19 on the surgical workforce, considerations for operating on a COVID-19 patient and the outcomes of such operations, the size and nature of the surgical backlog, and the logistics of resumption, including organizational considerations, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs to reduce morbidity, length of stay, and cost by rational, equitable resource utilization. Conclusions: Resumption of surgical services requires institutional commitment (including teams of surgeons, anesthesiologists, nurses, pharmacists, therapists, dieticians, and administrators). Structured protocols and equitable implementation programs, and iterative audit, planning, and integration will improve outcomes, enhance safety, preserve resources, and reduce cost, all of which will contribute to safe and successful reduction of the surgical backlog.

Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review

“…Most papers were identified as expert consensus (n=56, 44.8%), followed by literature review (n=35, 28.0%). Many articles described specific recommendations for performing intubation15–19 or for certain areas, such as psychiatric services,20–22 orthopaedics,23 haemodynamic,24 intrahospital transport,25 oncology,26 27 field hospitals,28 29 paediatrics,30–34 diagnostic centres,35–37 inpatient units,38–43 endoscopy and gastroenterology centres,44–48 gynaecology and obstetrics,40 49–55 emergency units,56–60 intensive care unit40 41 56 61–68 and the most common was the surgical centres 48 61 69–99. Other articles made recommendations for the hospital service as a whole 19 58 64 100–138.…”

“…The reorganisation of the health services category addresses 17 recommendations related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment in order to prevent the transmission of COVID-19. It is recommended that all patients are considered suspects47 70 80 90 91 101 128 and undergo risk stratification20 21 23 24 27 31 32 36 39 43–47 49 53 66 70 72–74 76 81 85 91 93 100–102 108 110 119 125 126 133 135 139 with a history of clinical and epidemiological data20 22–24 39 45–47 49 72 81 92 93 95 96 101 124–126 133–135 and a test20 22 23 26 30 39 48–51 53 61 65 68 72 73 81 84 90 92 96 102 110 119 124 133 of RT-PCR,23 36 47 69 72 81 87 88 91 96 119 125 126 133 134 ELISA23 47 or nasal swab84 95 101 at admission screening,21 22 36 39 49–51 53 69 95 108 133 in the preoperative period,23 26 47 48 61 69 72 87 90 95 102 124 in referrals31 84 and before non-emergency procedures involving airway approaches 66 79 95…”

“…To reduce the movement of people, hospitalisations and elective procedures should be suspended,20 23 26 36 37 40 46 48 51 52 69 72 75 76 84 91 95 96 98 100 101 108 110 124 125 134 the number of professionals in the areas of patients with COVID-19 should be kept to a minimum15 17 18 23 26 27 33 36 37 46–48 53 60 65 66 70 75 76 78 83–85 90 94 97–100 102 104 139 and family visits to patients should also be restricted 20–22 32 38 40 46 48 49 52–55 68 81 96 100 101 104 108 119 129 130 135 139…”

The Effect of the COVID-19 Pandemic on the Surgery Process

“…Before the operation, the general condition of the patient, the presence of active or recent respiratory or gastrointestinal symptoms, symptoms such as anosmia, fever, and a history of recent travel to an endemic country in the last 14 days or contact with a person at risk of contracting COVID-19 infection should be questioned. In cases requiring emergency surgery where the nasopharyngeal PCR test result cannot be expected, patients should be assumed to be infected with COVID-19 and should be approached similarly to infected patients (13,14). Thoracic computed tomography (CT) can be considered as an alternative to waiting for the PCR test result to determine the characteristic appearance of the lung, especially for patients with COVID-19 symptoms in emergency surgery (14).…”

Impact of COVID-19 on Global Kidney Transplantation Service Delivery: Interim Report

“…In November 2020, the picture was similar across Europe and the US: treatment delays for non-COVID-19-related conditions created a backlog that discussants felt would stretch resources for years ( 22 , 23 ).…”