The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper

Abstract

Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis

“…This change in practice is directly attributable to fear of COVID-19 spread via aerosolization during pneumoperitoneum evacuation, a concern that has controversially led to opposition of minimally invasive techniques during the initial phase of the pandemic [ 28 , 29 ]. Subsequently published guidelines from surgical societies have proposed reinstatement of minimally invasive techniques in both elective and emergency surgical practice, provided that precautionary protective practices, such as use of personal protective equipment, pneumoperitoneum release filters, and liberal preoperative COVID-19 molecular testing are followed [ 30 , 31 ]. Despite the reduced rates of minimally invasive technique utilization in the pandemic cohort, the length of hospital stay—although inconsistently reported in included studies—remained comparable between the two evaluated groups.…”

COVID-19 knowledge, attitudes, and practices of United Arab Emirates medical and health sciences students: A cross sectional study

“…However, only 24% in our study correctly recognized the route of COVID-19 transmission compared with other studies in which undergraduate students were quite knowledgeable about the route of transmission [ 22 , 23 ]. COVID-19 is transmitted by respiratory droplets; however, airborne transmission may be possible during a medical procedure that generates aerosols [ 38 ]. This lack of knowledge was unexpected, given that the majority of our respondents had access to freely available medical resources for this information.…”

The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey

“…In fact, for surgical procedures during the pandemic phases, only emergency and essential-elective surgeries (cancer and transplant surgery) are recommended to be performed. Recommendations suggest postponement of non-urgent cases, or conversion to alternative suitable non-operative/minimally invasive procedures [28][29][30]. As a result, interventional radiology departments are required to be highly adaptive and accommodate this inflow of patients from other medical disciplines.…”