Asunto(s)
Prueba de COVID-19/métodos , COVID-19/diagnóstico , COVID-19/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/estadística & datos numéricos , Cuidados Preoperatorios/métodos , COVID-19/prevención & control , Prueba de COVID-19/normas , Protocolos Clínicos , Atención a la Salud , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Seguridad del Paciente , Cuidados Preoperatorios/normas , TexasRESUMEN
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. METHODS: This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients' scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. RESULTS: A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. CONCLUSION: Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. LEVEL OF EVIDENCE: IV.
Asunto(s)
COVID-19/diagnóstico , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Ortopédicos/métodos , Cuidados Preoperatorios/métodos , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Estudios de Cohortes , Procedimientos Quirúrgicos Electivos/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/normas , Cuidados Preoperatorios/normas , Estudios Retrospectivos , Adulto JovenAsunto(s)
Prueba de Ácido Nucleico para COVID-19/tendencias , COVID-19/diagnóstico , COVID-19/epidemiología , Procedimientos Quirúrgicos Electivos/tendencias , Exámenes Obligatorios/tendencias , Cuidados Preoperatorios/tendencias , Prueba de Ácido Nucleico para COVID-19/normas , Niño , Procedimientos Quirúrgicos Electivos/normas , Femenino , Francia/epidemiología , Humanos , Masculino , Exámenes Obligatorios/normas , Cuidados Preoperatorios/normasAsunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/diagnóstico , Endoscopía/normas , Neumonía Viral/diagnóstico , Cuidados Preoperatorios/normas , Anticuerpos Antivirales/aislamiento & purificación , Infecciones Asintomáticas/epidemiología , Betacoronavirus/genética , Betacoronavirus/inmunología , COVID-19 , Prueba de COVID-19 , Control de Enfermedades Transmisibles/instrumentación , Control de Enfermedades Transmisibles/normas , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Gastroenterología/normas , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias/prevención & control , Equipo de Protección Personal/normas , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , ARN Viral/aislamiento & purificación , SARS-CoV-2 , Sociedades Médicas/normas , Estados UnidosRESUMEN
Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.
Asunto(s)
Prueba de COVID-19 , COVID-19 , Nariz/cirugía , Otolaringología/normas , Procedimientos Quirúrgicos Otorrinolaringológicos/normas , Pandemias , Equipo de Protección Personal/normas , Cuidados Preoperatorios/normas , Base del Cráneo/cirugía , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Otolaringología/métodos , Enfermedades Otorrinolaringológicas/cirugía , Cuidados Posoperatorios/normas , Cuidados Preoperatorios/métodosRESUMEN
Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. In this article, we provide an overview of the various laboratory testing methods that are presently available and a comprehensive literature review how various institutes and neurosurgical communities across the globe are employing them to ensure safe and effective delivery of surgical care to patients. Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.
Asunto(s)
Prueba de COVID-19/normas , COVID-19/epidemiología , Neurocirujanos/normas , Procedimientos Neuroquirúrgicos/normas , Guías de Práctica Clínica como Asunto/normas , Cuidados Preoperatorios/normas , COVID-19/diagnóstico , COVID-19/prevención & control , Prueba de COVID-19/métodos , Humanos , India/epidemiología , Neurocirugia/métodos , Neurocirugia/normas , Procedimientos Neuroquirúrgicos/métodos , Equipo de Protección Personal/normas , Cuidados Preoperatorios/métodos , Telemedicina/métodos , Telemedicina/normasAsunto(s)
Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/prevención & control , Endoscopía/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Cuidados Preoperatorios/normas , Adolescente , Adulto , Anciano , Infecciones Asintomáticas/epidemiología , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , COVID-19 , Prueba de COVID-19 , Niño , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/normas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa/estadística & datos numéricos , ARN Viral/aislamiento & purificación , Estudios Retrospectivos , SARS-CoV-2 , Centros de Atención Terciaria/estadística & datos numéricosAsunto(s)
COVID-19 , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/normas , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Ciudad de Roma/epidemiología , SARS-CoV-2Asunto(s)
Infecciones por Coronavirus/transmisión , Infección Hospitalaria/prevención & control , Tomografía Computarizada Cuatridimensional/métodos , Tamizaje Masivo/normas , Neumonía Viral/transmisión , Cuidados Preoperatorios/normas , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Tórax/diagnóstico por imagen , Adulto , Anciano , Betacoronavirus , COVID-19 , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Guías de Práctica Clínica como Asunto , SARS-CoV-2Asunto(s)
Prueba de COVID-19/normas , Procedimientos Quirúrgicos Cardíacos/normas , Enfermedades Endémicas/prevención & control , Exámenes Obligatorios/normas , Cuidados Preoperatorios/normas , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/cirugía , Personal de Salud/normas , Humanos , Exposición Profesional/prevención & control , Pandemias/prevención & controlAsunto(s)
COVID-19/epidemiología , Anomalías Maxilofaciales/cirugía , Prótesis Maxilofacial/normas , Pandemias , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , SARS-CoV-2 , Comorbilidad , Humanos , Anomalías Maxilofaciales/epidemiología , Estudios Retrospectivos , Interfaz Usuario-ComputadorRESUMEN
OBJECTIVES: The impact of the COVID-19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients. METHODS: This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders (cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendation on the conduct of TAVI during the pandemic. RESULTS: The COVID-19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, preprocedure COVID-19 testing, optimization of protests, and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days. CONCLUSION: The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendation on best practices may be a useful guide to help TAVI teams during this period until a COVID-19 vaccine becomes widely available.
Asunto(s)
COVID-19/epidemiología , Cuidados Preoperatorios/normas , Reemplazo de la Válvula Aórtica Transcatéter/normas , Estenosis de la Válvula Aórtica/cirugía , Asia/epidemiología , COVID-19/prevención & control , Prueba de COVID-19 , Humanos , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Tiempo de Internación/tendencias , Pandemias , Consulta Remota , Encuestas y Cuestionarios , TriajeRESUMEN
Since December 2019, a novel coronavirus disease, COVID-19, has occurred in China and has spread around the world rapidly. As an acute respiratory infectious disease, COVID-19 has been included in type B infectious diseases and managed according to the standard of type A infectious disease in China. Given the high risk of COVID-19 infection during endoscopic procedures via an airborne route, the Chinese Society of Digestive Endoscopy issued a series of recommendations to guide the endoscopy works in China during the pandemic. To the best of our knowledge, no new infectious case of COVID-19 resulting from endoscopic procedures has been reported in China to date. Here, these recommendations are integrated to provide guidance about the prevention of COVID-19 for endoscopists. The recommendations include advice about postponing non-urgent endoscopies, excluding the possibility of COVID-19 in patients undergoing endoscopy, protection of medical staff from coronavirus infection, and cleaning of endoscopy centres.
Asunto(s)
Infecciones por Coronavirus/prevención & control , Endoscopía Gastrointestinal/normas , Control de Infecciones/organización & administración , Pandemias/prevención & control , Equipo de Protección Personal/normas , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , COVID-19 , Prueba de COVID-19 , China/epidemiología , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Endoscopía Gastrointestinal/instrumentación , Contaminación de Equipos/prevención & control , Gastroenterología/métodos , Gastroenterología/normas , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/terapia , Personal de Salud/normas , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Quirófanos/normas , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Cuidados Preoperatorios/normas , SARS-CoV-2 , Sociedades Médicas/normasAsunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Monitoreo Epidemiológico , Neumonía Viral/diagnóstico , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/normas , Adulto , Anciano , COVID-19 , Prueba de COVID-19 , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Medición de Riesgo/normas , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology-head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS. STUDY DESIGN: Retrospective cohort study. SETTING: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC). SUBJECTS AND METHODS: OHNS cases from March 18 to April 8, 2020-the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020-were compared with a 2019 control data set. RESULTS: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases. CONCLUSION: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.
Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/diagnóstico , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Enfermedades Otorrinolaringológicas/cirugía , Neumonía Viral/diagnóstico , Cuidados Preoperatorios/estadística & datos numéricos , Adulto , Aerosoles , Anciano , COVID-19 , Prueba de COVID-19 , Niño , Preescolar , Procedimientos Quirúrgicos Electivos/legislación & jurisprudencia , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ohio , Otolaringología , Pandemias , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , Estudios Retrospectivos , Riesgo , SARS-CoV-2Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/prevención & control , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/normas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Oncología Quirúrgica/normas , Anciano , Betacoronavirus/genética , Betacoronavirus/patogenicidad , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Reacciones Falso Negativas , Femenino , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Italia/epidemiología , Masculino , Nasofaringe/cirugía , Nasofaringe/virología , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Equipo de Protección Personal/normas , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Cuidados Preoperatorios/instrumentación , Cuidados Preoperatorios/normas , Cuidados Preoperatorios/estadística & datos numéricos , ARN Viral/aislamiento & purificación , SARS-CoV-2 , Centros de Atención Terciaria/estadística & datos numéricos , Tiempo de TratamientoAsunto(s)
Disección Aórtica/cirugía , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Procedimientos Endovasculares/normas , Control de Infecciones/normas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Disección Aórtica/diagnóstico , Betacoronavirus/patogenicidad , COVID-19 , Prueba de COVID-19 , China/epidemiología , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Enfermedad Crítica/terapia , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/organización & administración , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Equipo de Protección Personal/normas , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Cuidados Preoperatorios/normas , SARS-CoV-2RESUMEN
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.