Global guidance for surgical care during the COVID-19 pandemic

Abstract Background Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. Methods A scoping search w...

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Published in:	British Journal of Surgery 2020-08, Vol.107 (9), p.1097-1103
Main Authors:	Bhangu, Aneel, Lawani, Ismail, Ng‐Kamstra, Joshua S, Wang, Yanfeng, Chan, Albert, Futaba, Kaori, Ng, Simon, Ebele, Emery, Lederhuber, Hans, Tabiri, Stephen, Ghosh, Dhruv, Gallo, Gaetano, Pata, Francesco, Di Saverio, Salomone, Spinelli, Antonino, Medina, Antonio Ramos‐De, Ademuyiwa, Adesoji O, Akinbode, Gbemisola, Ingabire, JC Allen, Ntirenganya, Faustin, Kamara, Thaim B, Goh, Minghui, Moore, Rachel, Kim, Hye Jin, Lee, Suk‐Hwan, Minaya‐Bravo, Ana, Abbott, Tom, Chakrabortee, Sohini, Denning, Max, Fitzgerald, J Edward, Glasbey, James, Griffiths, Ewen, Halkias, Constantine, Harrison, Ewen M, Jones, Conor S, Kinross, James, Lawday, Samuel, Li, Elizabeth, Markar, Sheraz, Morton, Dion G, Nepogodiev, Dmitri, Pinkney, Thomas D, Simoes, Joana, Warren, Oliver, Wong, Danny JN, Bankhead‐Kendall, Brittany, Breen, Kerry A, Davidson, Giana H, Kaafarani, Haytham, Keller, Deborah S, Mazingi, Dennis, Kamarajah, Sivesh K, Blackwell, Sue, Dames, Nicola
Format:	Article
Language:	eng
Subjects:	Coronavirus Infections - epidemiology Coronavirus Infections - prevention & control COVID-19 Cross Infection - prevention & control Emergency preparedness Humans Pandemics Pandemics - prevention & control Pneumonia, Viral - epidemiology Pneumonia, Viral - prevention & control Practice Guidelines as Topic - standards Review Surgeons Surgery Surgical Procedures, Operative - standards
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Summary:	Abstract Background Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. Methods A scoping search was conducted to identify published articles relating to management of surgical patients during pandemics. Key informant interviews were conducted with surgeons and anaesthetists with direct experience of working during infectious disease outbreaks, in order to identify key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic. Results Thirteen articles were identified from the scoping search, and surgeons and anaesthetists representing 11 territories were interviewed. To mount an effective response to COVID-19, a pandemic response plan for surgical services should be developed in advance. Key domains that should be included are: provision of staff training (such as patient transfers, donning and doffing personal protection equipment, recognizing and managing COVID-19 infection); support for the overall hospital response to COVID-19 (reduction in non-urgent activities such as clinics, endoscopy, non-urgent elective surgery); establishment of a team-based approach for running emergency services; and recognition and management of COVID-19 infection in patients treated as an emergency and those who have had surgery. A backlog of procedures after the end of the COVID-19 pandemic is inevitable, and hospitals should plan how to address this effectively to ensure that patients having elective treatment have the best possible outcomes. Conclusion Hospitals should prepare detailed context-specific pandemic preparedness plans addressing the identified domains. Specific guidance should be updated continuously to reflect emerging evidence during the COVID-19 pandemic. Graphical Abstract During pandemics, surgical services need to balance supporting the whole hospital response and minimizing the risk of nosocomial spread of COVID-19 against continuing care for acute surgical conditions and managing urgent elective surgery. This article identifies the key considerations that should be included in pandemic plans for surgical services. Graphical Abstract Best available advice
ISSN:	0007-1323 1365-2168