Evidence-Based Recommendations for Surgical Care during the COVID-19 Pandemic

Yıl 2020, Cilt: 5 Sayı: 2, 183 - 190, 30.06.2020

Deniz Şanlı

Öz

During the COVID-19 pandemic, surgical services should be provided at the highest level and health resources should be optimally used to save life, maintain organ function and avoid further damage of the underlying disease. In this review, we aimed to present evidence-based guideline recommendations to guide healthcare professionals who play a role in surgical care during the pandemic process. Hospitals should possess surgical resources appropriate for the number and type of surgical procedures performed and have policies regarding how and when to use these resources. Surgical priority levels should be given a thought. A safe and quality care should be provided throughout each stage of the perioperative care. The conditions for restarting elective surgery should be met. Preparing for the pandemic in the surgical environment includes changing the infrastructure and processes, personnel and material management, and infection prevention strategies. Surgical teams should respond appropriately to this worldwide public health crisis and adapt to the rapidly changing environment in order to improve patient outcomes and minimize the burden on the health system and society.

Anahtar Kelimeler

COVID-19, SARS-CoV-2, surgery, perioperative care

COVID-19 Pandemisinde Cerrahi Bakıma Yönelik Kanıta Dayalı Öneriler

Öz

Özet

COVID-19 pandemisi sırasında yaşamı kurtarmak, organ işlevini korumak, altta yatan hastalığın daha fazla zarar vermesinden kaçınmak için cerrahi hizmetlerin en yüksek düzeyde sağlanması ve sağlık kaynaklarının en uygun şekilde kullanılması gerekmektedir. Bu derlemede, pandemi sürecinde cerrahi bakımda rol alan sağlık çalışanlarına uygulamalarında yol göstermek üzere kanıta dayalı kılavuz önerilerinin sunulması amaçlanmıştır. Hastaneler, yapılan cerrahi işlemlerin sayısı ve türüne uygun cerrahi kaynaklara ve bunların nasıl ve ne zaman kullanılacağına ilişkin politikalara sahip olmalıdır. Cerrahi öncelik düzeyleri düşünülmelidir. Perioperatif bakımın her aşaması boyunca güvenli ve kaliteli bakım sağlanmalıdır. Elektif cerrahiye yeniden başlama koşulları karşılanmalıdır. Cerrahi ortamda pandemi için hazırlık, altyapı ve süreçlerin değiştirilmesini, personel ve malzeme yönetimini ve enfeksiyon önleme stratejilerini içerir. Cerrahi ekipler, hasta sonuçlarını iyileştirmek, sağlık sistemi ve toplum üzerindeki yükü en aza indirmek için dünya çapındaki bu toplum sağlığı krizine uygun şekilde yanıt vermeli, hızla değişen ortama uyum sağlamalıdır.

Anahtar Kelimeler: COVID-19, SARS-CoV-2, cerrahi, perioperatif bakım.

Abstract

During the COVID-19 pandemic, surgical services should be provided at the highest level and health resources should be optimally used to save life, maintain organ function and avoid further damage of the underlying disease. In this review, we aimed to present evidence-based guideline recommendations to guide healthcare professionals who play a role in surgical care during the pandemic process. Hospitals should possess surgical resources appropriate for the number and type of surgical procedures performed and have policies regarding how and when to use these resources. Surgical priority levels should be given a thought. A safe and quality care should be provided throughout each stage of the perioperative care. The conditions for restarting elective surgery should be met. Preparing for the pandemic in the surgical environment includes changing the infrastructure and processes, personnel and material management, and infection prevention strategies. Surgical teams should respond appropriately to this worldwide public health crisis and adapt to the rapidly changing environment in order to improve patient outcomes and minimize the burden on the health system and society.

Keywords: COVID-19, SARS-CoV-2, surgery, perioperative care.

Anahtar Kelimeler

COVID-19, SARS-CoV-2, cerrahi, perioperatif bakım

Kaynakça

• American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN), American Hospital Association (AHA). (2020, April 17). Joint statement: Roadmap for resuming elective surgery after COVID-19 pandemic. Retrieved May 19, 2020, from https://www.facs.org/-/media/files/covid19/joint_statement_resuming_ elective_surgery_after_covid19.ashx
• American College of Surgeons (ACS). (2020a, March 13). COVID-19: Recommendations for management of elective surgical procedures. Retrieved May 20, 2020, from https:// www.facs.org/-/media/ files/covid19/recommendations_for_management_of_elective_ surgical_procedures.ashx
• American College of Surgeons (ACS). (2020b, April 17). Local resumption of elective surgery guidance. Retrieved May 19, 2020, from https:// www.facs.org/-/media/files/covid19/local_resumption_of_ elective_surgery_guidance.ashx
• Aminian, A., Safari, S., Razeghian-Jahromi, A., Ghorbani, M., Delaney, C.P. (2020). COVID-19 outbreak and surgical practice: unexpected fatality in perioperative period. Annals of Surgery. doi: 10.1097/ SLA.0000000000003925
• Brindle, M.E., Gawande, A. (2020). Managing COVID-19 in surgical systems. Annals of Surgery. doi: 10.1097/SLA.0000000000003923
• Centers for Disease Control and Prevention (CDC). (2020, May 18). Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. Retrieved May 20, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infectioncontrol- recommendations.html
• Centers for Medicare and Medicaid Services (CMS). (2020, April 7). CMS adult elective surgery and procedures recommendations: Limit all non-essential planned surgeries and procedures, including dental, until further notice. Retrieved May 5, 2020, from https://www.cms. gov/files/document/covid-elective-surgery-recommendations. pdf
• Lei, S., Jiang, F., Su, W., Chen, C., Chen, J., Mei, W., et al. (2020). Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine, 21. https://doi.org/10.1016/j. eclinm.2020.100331
• National Health Service (NHS) England and NHS Improvement. (2020, April 11). Clinical guide to surgical prioritisation during the coronavirus pandemic. Retrieved May 5, 2020, from https:// www.england.nhs.uk/coronavirus/wp-content/uploads/ sites/52/2020/03/C0221-specialty-guide-surgical-prioritisation-v1. pdf
• Ran, L., Chen, X., Wang, Y., Wu, W., Zhang, L., Tan, X. (2020). Risk factors of healthcare workers with corona virus disease 2019: A retrospective cohort study in a designated hospital of Wuhan in China. Clinical Infectious Diseases, 17. doi: 10.1093/cid/ciaa287
• Royal Australasian College of Surgeons (RACS). (2020, May 5). Surgery triage: Responding to the COVID-19 pandemic. Retrieved May 20, 2020, from https://umbraco.surgeons.org/ media/5254/2020-04-22_racs-triage-of-surgery-web.pdf
• Royal College of Surgeons of England (RCS). (2020a, March 20). Guidance for surgeons working during the COVID-19 pandemic from the Surgical Royal Colleges of the United Kingdom and Ireland. Retrieved May 5, 2020, from https://www.rcseng.ac.uk/coronavirus/jointguidance- for-surgeons-v1/
• Royal College of Surgeons of England (RCS). (2020b, April 6). Updated intercollegiate general surgery guidance on COVID-19. Retrieved May 5, 2020, from https://www.rcseng.ac.uk/coronavirus/jointguidance- for-surgeons-v2/
• Royal College of Surgeons of England (RCS). (2020c, April 29). Recovery of surgical services during and after COVID-19. Retrieved May 12, 2020, from https://www.rcseng.ac.uk/coronavirus/recovery-ofsurgical- services/
• Ti, L.K., Ang, L.S., Foong, T.W., Ng, B.S.W. (2020). What we do when a COVID-19 patient needs an operation: Operating room preparation and guidance. Canadian Journal of Anesthesia, 67, 756-758. https:// doi.org/10.1007/s12630-020-01617-4
• Wong, J., Goh, Q.Y., Tan, Z., Lie, S.A., Tay, Y.C., Ng , S.Y. et al. (2020). Preparing for a COVID-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. Canadian Journal of Anesthesia, 67, 732-745. https://doi. org/10.1007/s12630-020-01620-9