The Fact of Sars-CoV-2 (COVID-19) and Current Surgical Approach Recommendations of Zonguldak Bulent Ecevit University The School of Medicine General Surgery Department During Pandemic

Year 2020, Volume: 4 Issue: 1, 1 - 6, 30.04.2020

Güldeniz Karadeniz Çakmak , Mustafa Cömert

Abstract

The accelerating case numbers of COVID-19 in Asia, Europe and America obliged us to take strict precautions in order to restrain

community transmission in hospitals where diagnosis, treatment and management are actively performed. Turkish Ministry of Health

issued a circular on time to stop all elective procedures, but emergency and oncologic cases. During COVID-19 pandemic, we,

as surgeons take the responsibility to assist caring infected patients, in addition to perform emergency surgery and operate on

oncologic cases for whom deferring surgery has a negative impact on prognosis. Surgical interventions are the basic community

health services categorized as elective and emergent. Operating theaters are the places with high risk of transmission of respiratory

infections due to emergencies, high volume of personnel, and airway procedures to be done. Our institutes and systems are very

well prepared to usual high-risk transmission status. However, in extraordinary circumstances like pandemics, high prevalence

of disease and limited resources led to great pressure over surgical and operative team which has the potential to increase the

system load and tendency to make mistakes. Accordingly, our primary mission is to act immediately to protect our team and patients

via preserving and appropriately utilizing valuable resources in order to maintain surgical functioning in terms of emergency. The

priority should be to design our surgical approach dynamically in regard to the COVID-19 status and resources of the facility we are

working in. We, Zonguldak Bülent Ecevit University The School of Medicine Department of General Surgery aimed to redesign our

surgical algorithms during Covid-19 pandemic according to Turkish Ministry of Health circular and experiences of our colleagues and

recommendations of the international surgical societies guidelines. To share our experiences, practices and recommendations is out

most important in these days during which we do not have enough time to wait for the data with high level of evidence. Surgeons

should pay great attention on their facility’s COVID-19 status and resources before surgical decision making to establish best clinical

practice and save patients’ lives during these unprecedented period of time.

Keywords

COVID-19, Pandemic, Surgery

Sars-CoV-2 (COVID-19) Gerçeği ve Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı Pandemi Sürecinde Güncel Cerrahi Yaklaşım Önerileri

Abstract

COVID-19, Asya, Avrupa ve Amerika kıtasında yüksek ivme ile yayılırken, özellikle hastaneler

hastalığın tedavisi ve yayılımı konusunda en aktif noktalar olup topluma transmisyonun artmaması

adına katı tedbirlerin alınması gerekliliği ortaya çıktı. Türkiye’de Sağlık Bakanlığı genelgesi ile

acil ve ertelenemeyecek onkolojik vakalar dışında tüm elektif cerrahi müdahalalerin durdurulması

sağlandı. Bu pandemi sürecinde cerrahlar olarak enfekte hastaları iyileştirmeye yardım etmenin

yanısıra cerrahiyi ertelemenin prognozu etkileyecek hastalar ile acil cerrahi uyguladığımız hastalarımızın

sorumluluğunu almakla yükümlüyüz. Cerrahi girişimler elektif ve acil girişimler şeklinde

tüm sağlık sistemleri içinde yer alan temel toplum sağlığı hizmetleridir. Ancak, ameliyathaneler

acil durumlar, çok sayıda ekip elemanının görev alması ve havayolu müdahalesi gibi yüksek

transmisyon riskine sahip aktiviteler sebebi ile solunum yolu enfeksiyonlarının yayılımı açısından

yüksek risk bölgeleridir. Hastanelerimiz ve sistemlerimiz olağan, yüksek riskli transmisyon durumları

için oldukça iyi şekilde organize edilmiş olmasına karşın, pandemi durumları gibi hastalık

prevelansının yüksek, kaynak kısıtlılıklarının olası, ekip üzerindeki baskı ve basıncın fazla olduğu

durumlar transmisyon riskini yükselterek sistemin zaten ağır olan yükünü artırma potansiyeli taşımaktadır.

Bu nedenle görevimiz hemen harekete geçerek değerli kaynaklar ile hasta ve ekibimizi

koruyarak sistemimizin elzem cerrahi girişimlere destek verebilmesini sağlamaktır. Tüm zorluklara

rağmen dünya genelinde meslektaşlarımızın tecrübelerinden de faydalanarak pandemi süresince

kurumumuzun COVID-19 statüsü ve kaynaklarını rasyonel ve dinamik şekilde dikkate alıp cerrahi

yaklaşımımızı planlamak önceliğimiz olmalıdır. Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi

Genel Cerrahi Anabilim Dalı olarak pandemi süresince uygulayacağımız cerrahi yönetim planımızı

Sağlık Bakanlığımız genelgesi doğrultusunda Amerika Birleşik Devletleri, Avrupa ve Asya’da

pandeminin hızla yayıldığı ülkelerin cerrahi dernek önerilerini dikkate alarak dizayn etmeyi amaçladık.

Hekimler olarak deneyim, uygulama ve önerilerimizi paylaşmamız yüksek kanıt düzeyine

sahip verileri bekleme şansımızın olmadığı bu süreçte, hastanemizin COVID-19 durumunu ve

kaynak miktarını göz önünde bulundurarak hastalarımıza yarar sağlayacak en iyi uygulamaların

kullanıma girmesi ve hayatların kurtarılması adına büyük önem taşımaktadır

Keywords

covid-19, pandemi, cerrahi

References

• 1. Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States. Centers for Disease Control and Protection. Published 29th Feb, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html
• 2. COVID-19: Elective Case Triage Guidelines for Surgical Care Up Online March 24, 2020, FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case
• 3. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations
• 4. Create a Surgical Review Committee for COVID-19-Related Surgical Triage Decision Making, Online March 24, 2020. Developed by the American College of Surgeons, American Society of Anesthesiologists, and Association of periOperative Registered Nurses FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/review-committee
• 5. COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures, Online March 17, 2020. FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/triage
• 6. COVID-19 Guidelines for Triage of Cancer Surgery Patients.Online March 24, 2020.FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case/cancer-surgery
• 7. COVID-19 Guidelines for Triage of Breast Cancer Patients.Online March 24, 2020. https://www.facs.org/covid-19/clinical-guidance/elective-case/breast-cancer
• 8. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary Version 1.0 The COVID-19 Pandemic Breast Cancer Consortium. March 24, 2020. https://www.breastsurgeons.org/docs/news/The_COVID
• 9. Ontario Health, Cancer Care Ontario, “Pandemic Planning Clinical Guideline for Patients with Cancer”, https://www.accc-cancer.org/docs/document/cancer-program-fundamentals/oh-ccopandemic-planning-clinical-guidelines (accessed March 23, 2020)
• 10. Resource for Management Options of Breast Cancer During COVID-19 March 23, 2020, Society of Surgiacal Oncology. https://www.surgonc.org/wp-content/uploads/2020/03/Breast-Resource-during-COVID-19-3.23.20.pdf
• 11. Statement on COVID-19. Advice for Surgical Oncologists on Cancer Service Provision. 27th March, 2020 European Society of Surgical Oncology. https://www.essoweb.org/news/esso-statement-covid-19/
• 12. Guidance for surgeons working during the COVID-19 pandemic. Royal Collage of Surgeons, 20 March 2020. https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/
• 13. COVID-19 Patient Care Information. 13 March 2020. https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19
• 14. SAGES Recommendations Regarding Surgical Response to COVID-19 Crisis March 19, 2020 by Julie Miller. Available at: https://www.sages.org/recommendations-surgical-response-covid-19/
• 15. Experimental study of the potential hazards of surgical smoke from powered instruments. In SM, Park DY, Sohn IK, et al. Br J Surg. 2015, 102:1581––1586.
• 16. Studies on the transmission of viral disease via the CO2 laser plume and ejecta. Wisniewski PM, Warhol MJ, Rando RF, Sedlacek TV, Kemp JE, Fisher JC. J Reprod Med. 1990, 35:1117–23.