ABSTRACT
Head and neck cancer patients with tracheostomies and laryngectomies, as well as their healthcare providers, face unique challenges in the context of the current COVID-19 pandemic. This document consolidates best available evidence to date and presents recommendations to minimize the risks of aerosolization and SARS-CoV-2 exposures in both the inpatient and outpatient settings. The cornerstones of these recommendations include the use of closed-circuit ventilation whenever possible, cuffed tracheostomy tubes, judicious use of heat moisture exchange units, appropriate personal protective equipment for providers and patients, meticulous hand hygiene, and minimal manipulation of tracheostomy tubes.
Subject(s)
Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Head and Neck Neoplasms/surgery , Laryngectomy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tracheostomy/methods , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Evidence-Based Medicine , Female , Head and Neck Neoplasms/pathology , Humans , Male , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Risk Assessment , Surgical Oncology/standards , United StatesABSTRACT
The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgent-consider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.