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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321598

ABSTRACT

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients in emergency setting under COVID-19 pandemic in the safety of the patient and health care workers based on available evidences and experienced surgeons’opinion.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P)through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to provide a guide for emergency surgeons to perform safely surgery during this pandemic on the basis of evidence medicine and principles of mass casualty incident management to limit the diffusion of the infection among patients and health care workers. ConclusionsWe recommend screening for COVID-19 infection at emergency department, all surgical patients with clinical and epidemiologic features suspect for COVID-19 disease who are waiting for hospital admission and urgent surgery. The screening provides performing a RT-PCR naso-pharyngeal swab test and a baseline (non-contrast) chest CT or chest X-ray or lungs US, depending on skills and availability.The management of COVID-19 surgical patient is multidiplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every efforts to protect the operating room staff, in the safety of the patient . We recommend not being present during the intubation and extubation maneuvers (1A).To perform a safe surgical procedure, we recommend:-having a trained staff, wearing the necessary personal protective equipments, and an established protocol for the preoperative, peri-operative and postoperative management of the COVID-19 surgical patient;-being careful in the establishment and management of the artificial pneumoperitoneum, in the control of the hemostasis and of incisions to prevent any loss of biological fluids and contamination of the surgical staff;-using of all available devices to remove smoke and aerosol during the operation and a closed suction system for artificial pneumoperitoneum, especially if there is a risk of conversion to laparotomy.If it is not possible to perform surgery in a safe and protected environment, we recommend do not underestimating the highest risk of contamination and infection for health care workers and dissemination of the virus in the hospital and to consider transferring the patient in a COVID HUB hospital for the appropriate management.The administration of prophylactic anticoagulation with LMWH is recommended as soon as possible in COVID-19 patients to reduce thromboembolic risk related to the virus and sepsis, decreasing the mortality rate. We recommend to carefully administrating antibiotics in COVID-19 surgical patients for the high risk of selecting resistant bacteria, especially in patients admitted in ICU for mechanical ventilation. Early empirical antibiotic treatment should be targeted to results from cultures, with de-escalation of treatment as soon as possible. We recommend against empirical antifungal treatment in all surgical COVID-19 patients but to consider it in critically ill patients.

2.
Ann Surg Oncol ; 28(9): 4816-4826, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1190139

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related risks to patients and healthcare workers following the re-introduction of major oesophago-gastric (EG) surgery. PATIENTS AND METHODS: This was an international, multi-centre, observational study of consecutive patients treated by open and minimally invasive oesophagectomy and gastrectomy for malignant or benign disease. Patients were recruited from nine European centres serving regions with a high population incidence of COVID-19 between 1 May and 1 July 2020. The primary endpoint was 30-day COVID-19-related mortality. All staff involved in the operative care of patients were invited to complete a health-related survey to assess the incidence of COVID-19 in this group. RESULTS: In total, 158 patients were included in the study (71 oesophagectomy, 82 gastrectomy). Overall, 87 patients (57%) underwent MIS (59 oesophagectomy, 28 gastrectomy). A total of 403 staff were eligible for inclusion, of whom 313 (78%) completed the health survey. Approaches to mitigate against the risks of COVID-19 for patients and staff varied amongst centres. No patients developed COVID-19 in the post-operative period. Two healthcare workers developed self-limiting COVID-19. CONCLUSIONS: Precautions to minimise the risk of COVID-19 infection have enabled the safe re-introduction of minimally invasive and open EG surgery for both patients and staff. Further studies are necessary to determine the minimum requirements for mitigations against COVID-19.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Humans , Minimally Invasive Surgical Procedures , SARS-CoV-2
3.
World J Emerg Surg ; 16(1): 14, 2021 03 22.
Article in English | MEDLINE | ID: covidwho-1146830

ABSTRACT

BACKGROUND: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. METHOD: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. RESULTS: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion. CONCLUSIONS: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.


Subject(s)
COVID-19/prevention & control , Infection Control/standards , Perioperative Care/standards , Surgical Procedures, Operative/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/methods , COVID-19 Testing/standards , Emergencies , Global Health , Humans , Infection Control/instrumentation , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Laparoscopy/standards , Pandemics , Perioperative Care/methods , Personal Protective Equipment , Surgical Procedures, Operative/methods
4.
The New Microbiologica ; 43(4):156, 2020.
Article in English | ProQuest Central | ID: covidwho-1136750

ABSTRACT

The SARS-CoV-2 pandemic has already reached 3,207,248 patients with more than 225,000 deaths all over the world. Colorectal cancer is the third most diagnosed cancer worldwide, and the healthcare system is struggling to manage daily activities for elective cancer surgery. This review integrates clinical, microbiological, architectural and surgical aspects to develop indications on strategies to manage colorectal cancer patients and ensure safety during the pandemic. Telephone or virtual clinics must be encouraged and phone follow-up should be implemented. Indications for surgery must be rigorous, balancing the advantage of early surgical treatment and risks of treatment delay. To decrease the occupancy rate of intensive care unit beds, elective surgical treatment should be delayed until local endemic control, according to stage of disease. Patients with SARS-CoV-2 infection should be treated only after clinical recovery, two consecutive negative oropharyngeal swabs and, if available, a negative stool sample. Before any elective oncologic procedure, a multidisciplinary oncologic team including an anaesthesiologist and an infectious disease specialist must assess every patient to evaluate the risk of infection and its impact on perioperative morbidity, mortality and oncologic prognosis. The hospital should organise to manage all elective oncologic patients in an 'infection-free' area or refer them to a non-SARS-CoV-2 hospital.

5.
World J Emerg Surg ; 15(1): 36, 2020 05 24.
Article in English | MEDLINE | ID: covidwho-342959

ABSTRACT

BACKGROUND: COVID-19 pandemic has rapidly spread in Italy in late February 2020. Almost all surgical services have been reorganized, with the aim of maintaining an adequate therapeutic path, especially for surgical emergencies. The knowledge of how surgeons dealing with emergency surgery have reacted to the epidemic in the real life can be useful while drafting clinical recommendations. METHODS: Surgeons from multiple Italian regions were invited answering to an online survey in order to make a snapshot of their current behaviors towards COVID-19-positive patients bearing urgent surgical diseases. Questions about institutional rules and personal approach for patient treatment and to limit epidemic spread were included in a 37-item questionnaire. RESULTS: Seventy-one questionnaires from institutions dealing with emergency surgery were accepted. Participating surgeons were equally subdivided from a geographical point of view, with a large proportion of public (97.2%) and non-academical (91.5%) centers. In 80.3% of cases, the hospitals treated COVID-19 patients; in 69.1% of centers, a change in work plan was necessary, and 33.8% of teams had almost a surgeon infected or in preventive quarantine. The vast majority of surgeons operated only on urgent cases (73.9%), but the number of interventions significantly dropped. Up to 40% of non-traumatic abdominal emergency cases had an unusual delayed treatment. The laparoscopic approach was used in 69.6% of interventions on COVID-19 patients. Strategies to protect health care workers against COVID-19 infection and to identify asymptomatic infected surgeons were suboptimal with respect to the WHO recommendations in 70.4% and 90.2% of centers, respectively. Advanced personal protective equipment for operating room workers was adopted for all surgeries in only 12.7% of centers. DISCUSSION: This survey confirms that the COVID-19 outbreak is dramatically changing the practice of emergency surgery centers in Italy. Despite the reduction in number, urgent cases were on average more challenging owing to diagnostic delay. Recommendations from the International Scientific Societies are frequently not complied concerning the use of laparoscopic approach, the availability of personal protective equipment in the operating rooms, and the testing of both asymptomatic physicians and patients scheduled for surgery. A further evaluation of the short-term results of these attitudes is warranted to modulate international recommendations.


Subject(s)
Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , General Surgery/organization & administration , Infection Control/standards , Intensive Care Units/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Professional Practice/standards , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Emergencies , Hospitals/statistics & numerical data , Humans , Italy/epidemiology , Laparoscopy/methods , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Surveys and Questionnaires
6.
Updates Surg ; 72(2): 249-257, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-324541

ABSTRACT

BACKGROUND: The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation. METHODS: A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regarding qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak. RESULTS: Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colorectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers. DISCUSSION: Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers participating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency.


Subject(s)
Colon/surgery , Coronavirus Infections/epidemiology , Digestive System Surgical Procedures/statistics & numerical data , Disease Outbreaks , Elective Surgical Procedures/statistics & numerical data , Pneumonia, Viral/epidemiology , Rectum/surgery , COVID-19 , Humans , Italy/epidemiology , Pandemics , Surveys and Questionnaires , Time Factors
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