Belinda De Simone1, Elie Chouillard2, Massimo Sartelli3, Walter L Biffl4, Salomone Di Saverio5, Ernest E Moore6, Yoram Kluger7, Fikri M Abu-Zidan8, Luca Ansaloni9, Federico Coccolini10, Ari Leppänemi11, Andrew B Peitzmann12, Leonardo Pagani13, Gustavo P Fraga14, Ciro Paolillo15, Edoardo Picetti16, Massimo Valentino17, Emmanouil Pikoulis18, Gian Luca Baiocchi19, Fausto Catena20. 1. Service de Chirurgie Générale, Digestive, Metabolique, Centre Hospitalier de Poissy/Saint Germain en Laye, Poissy, France. desimone.belinda@gmail.com. 2. Service de Chirurgie Générale, Digestive, Metabolique, Centre Hospitalier de Poissy/Saint Germain en Laye, Poissy, France. 3. Department of General Surgery, Macerata's Hospital, Macerata, Italy. 4. Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA. 5. Department of General Surgery, University Hospital of Varese, University of Insubria, Varese, Italy. 6. Trauma Surgery, Denver Health, Denver, CO, USA. 7. Department of Emergency and Trauma Surgery, Rambam Health Campus, Haifa, Israel. 8. Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. 9. Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy. 10. Department of Surgery, University of Pisa, Pisa, Italy. 11. Abdominal Center, University Hospital Meilahti, Helsinki, Finland. 12. University of Pittsburgh School of Medicine, F-1281, UPMC-Presbyterian, Pittsburgh, PA, 15213, USA. 13. Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy. 14. Departamento de Cirurgia, Faculdade de Ciências Médicas (FCM) -Unicamp, Campinas, SP, Brazil. 15. Spedali Civili di Brescia, ASST degli Spedali Civili di Brescia, 25123, Brescia, Italy. 16. Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. 17. Department of Radiology, Tolmezzo Hospital, Tolmezzo, Italy. 18. Department of Surgery, Attikon General Hospital, National & Kapodistrian University of Athens (NKUA), Athens, Greece. 19. Department of Surgery, University of Brescia, Brescia, Italy. 20. Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.
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.
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-19patients needing for an emergency surgical treatment. We recommend screening for COVID-19infection 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 COVIDpatient. 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.
Entities:
Keywords:
2019-nCoV; COVID-19; Emergency surgery; Follow-up; Laparoscopy; Non operative management; Open surgery; Pandemic; Personal protective equipment; Postoperative care; SARS-CoV-2; Screening; Trauma surgery
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