Surgeons release guidelines for resuming elective surgery during the COVID-19 pandemic
A panel of expert physicians in orthopedic surgery has released recommendations aimed at reducing the transmission of the COVID-19 virus during the resumption of elective surgical procedures.
According to the study, the guidelines are based on available scientific evidence, “albeit scant,” and have been voted on and reviewed by a panel of 77 physicians in orthopedic surgery, infectious disease, microbiology, virology and anesthesia, according to lead author Javad Parvizi, MD, FRCS, and colleagues with the International Consensus Group and the research committee of the American Association of Hip and Knee Surgeons.
“As we resume elective surgical procedures, it is important to understand what practices and protocols should be altered or implemented in order to minimize the risk of pathogen transfer during the severe acute respiratory syndrome (SARS)-CoV-2 pandemic,” Parvizi and colleagues wrote in the study. “Each hospital and health system should consider their unique situation in terms of SARS-CoV-2 prevalence, staffing capabilities, personal protection equipment supply, and so on when determining how and when to implement these recommendations,” they added.
Included in the guidelines are preoperative, intraoperative and postoperative protocols, and recommendations on a range of topics from risk-stratification and PPE use to age restrictions, testing and anesthesia.
Patients who are currently infected by the virus, patients aged 75 years or older and immunocompromised patients could possibly be deferred for elective surgery, according to the guidelines.
“It is the opinion of this group that elective surgery should be delayed in patients with active COVID-19 until they are shown to have recovered from the infection as dened by local guidelines,” the authors wrote. “Patients with substantial comorbidities and risk factors should be scheduled after healthier patients have been treated and experience has been amassed from the establishment of screening, prevention and treatment protocols,” they added.
“Testing of patients should be mandatory in high-prevalence areas given the risk of disease transmission by asymptomatic patients,” the authors wrote. “Routine testing is not feasible in all locations because of limitations in testing capacity, and therefore local guidelines should be followed in these areas.”
The panel also reached a consensus on mask and social distancing mandates for all patients and providers, as well as the alteration of general anesthesia protocols.
“General anesthesia that requires airway manipulation, endotracheal intubation and positive ventilation is more likely to predispose the anesthesia and surgical team to transmission of SARS-CoV-2,” Parvizi and colleagues wrote. “The use of regional anesthesia, whenever possible, should be strongly considered,” they added.
“We realize that the situation is evolving on a daily basis and that some of the recommendations in the present report may need to be altered as new evidence emerges,” the authors wrote. “In addition, we are aware that the infection-prevention measures described in the present report will highly depend on the prevalence of COVID-19 in the affected areas and the ability to implement the recommended diagnostic tests to properly rule out COVID-19 prior to surgery. We will continue to monitor the literature and update this document as needed,” they concluded.