Abstract
Based on high quality surgery and scientific data, scientists and surgeons are committed to protecting patients as well as healthcare staff and hereby provide this Guidance to address the special issues circumstances related to the exponential spread of the Coronavirus disease 2019 (COVID-19) during this pandemic. As a basis, the authors used the British Intercollegiate General Surgery Guidance as well as recommendations from the USA, Asia, and Italy. The aim is to take responsibility and to provide guidance for surgery during the COVID-19 crisis in a simplified way addressing the practice of surgery, healthcare staff and patient safety and care. It is the responsibility of scientists and the surgical team to specify what is needed for the protection of patients and the affiliated healthcare team. During crises, such as the COVID-19 pandemic, the responsibility and duty to provide the necessary resources such as filters, Personal Protective Equipment (PPE) consisting of gloves, fluid resistant (Type IIR) surgical face masks (FRSM), filtering face pieces, class 3 (FFP3 masks), face shields and gowns (plastic ponchos), is typically left up to the hospital administration and government. Various scientists and clinicians from disparate specialties provided a Pandemic Surgery Guidance for surgical procedures by distinct surgical disciplines such as numerous cancer surgery disciplines, cardiothoracic surgery, ENT, eye, dermatology, emergency, endocrine surgery, general surgery, gynecology, neurosurgery, orthopedics, pediatric surgery, reconstructive and plastic surgery, surgical critical care, transplantation surgery, trauma surgery and urology, performing different surgeries, as well as laparoscopy, thoracoscopy and endoscopy. Any suggestions and corrections from colleagues will be very welcome as we are all involved and locked in a rapidly evolving process on increasing COVID-19 knowledge.
Highlights
On January 30, 2020 the World Health Organization (WHO) stated on its Situation Report – 10 that “the Emergency Committee on the novel coronavirus (2019-nCoV) under the International Health Regulations (IHR 2005) is meeting today to discuss whether the outbreak constitutes a public health emergency of international concern” [1] and stated on March 11, 2020 in its Situation Report – 51, that “. . ..the assessment that the Coronavirus disease 2019 (COVID-19) can be characterized as a pandemic” [2].COVID-19 is caused by a single-stranded ribonucleic acid virus associated with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which was first detected in Wuhan, Hubei province in China in December 2019 [3]
SARS-CoV-2 circulated among individuals for several weeks and one way it likely entered Europe was through an unrecognized infection by a traveler from Singapore to France on January 24, 2020 where some 21 people were exposed at a ski resort [6]
We review at first the development of how recommendations were created and point out, which knowledge needs to be taken into account, which explains why the stated risk of laparotomy compared to laparoscopy needs to be seen in a much more differentiated way if available knowledge is addressed and some conditions are considered
Summary
On January 30, 2020 the World Health Organization (WHO) stated on its Situation Report – 10 that “the Emergency Committee on the novel coronavirus (2019-nCoV) under the International Health Regulations (IHR 2005) is meeting today to discuss whether the outbreak constitutes a public health emergency of international concern” [1] and stated on March 11, 2020 in its Situation Report – 51, that “. . ..the assessment that the Coronavirus disease 2019 (COVID-19) can be characterized as a pandemic” [2]. Some 80% of infections will be mild, and 20% will be moderate or seriously ill These data have made clear that such an outbreak with an exponential increase of infected patients can rapidly overwhelm any healthcare system. The following recommendations serve as Pandemic Surgery Guidance during the current exponential spread of the COVID-19 throughout the world (Fig. 3). The objective is to take responsibility to provide guidance for surgery in the COVID-19 crisis in a more practical way addressing practice, healthcare staff and patient safety. Guidance is a simplified way to address decision-making for our colleagues and staff performing surgery, for the healthcare team and to ensure patient safety and care (Fig. 3). ! COVID-19-testing and risk assessment. ! Pneumonia assessment by plain chest X-ray versus 3 quadrant ultrasound versus thoracic CT. ! Every surgery entails higher patient and staff risk
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