The American College of Surgeons released new surgical triage guidelines on surgical decision-making for curtailing elective surgical procedures to preserve necessary resources for the care of critically ill patients during the COVID-19 pandemic.
Titled “COVID-19: Elective Case Triage Guidelines for Surgical Care,” the guidelines were developed following expert review in several specialties to provide trusted information from the most current, best evidence available, according to a press release. The release noted the triage recommendations should be used in conjunction with a joint recommendation from the ACS, American Society of Anesthesiologists and the Association of periOperative Registered Nurses that medical centers develop a surgical review committee to act as an administrative body to provide defined, transparent and responsive oversight for triaging surgical cases. Decisions of the surgical review committee regarding surgical cases should be made on a daily basis, no later than the day before an operation and should include a multidisciplinary leadership team representing surgery, anesthesiology and nursing, according to the joint recommendation.
Among its guidelines, the ACS recommends surgeons that should consider nonoperative management whenever clinically appropriate. The ACS noted appropriate and timely surgical care should be based on sound surgical judgment and availability of resources, and emergency surgical procedures should be avoided at night, when possible, due to limited team staffing. Surgeons should also wait on results of COVID-19 testing in patients who may be infected, and aerosol generating procedures should only be performed while wearing full personal protective equipment including an N95 mask or powered, air-purifying respirator that has been designed for the OR, according to the ACS.
The release noted guidelines are available for the following:
- colorectal cancer surgery;
- emergency general surgery;
- metabolic-bariatric surgery;
“These triage guidelines and joint recommendations are being issued as we appear to be entering a new phase of the COVID-19 pandemic with more hospitals facing a potential push beyond their resources to care for critically ill patients,” David B. Hoyt, MD, FACS, executive director of the ACS, said in the release. “ACS will continue to monitor the landscape for surgical care but we feel this guidance document provides a sound foundation for surgeons to begin enacting these triage recommendations today to help them make the best decisions possible for their patients during COVID-19.”