General surgery and COVID-19: review of practical recommendations in the first pandemic phase
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REVIEW ARTICLE
General surgery and COVID‑19: review of practical recommendations in the first pandemic phase Vittorio Bresadola1 · Carlo Biddau1 · Alessandro Puggioni1 · Alessandro Tel2 · Massimo Robiony2 · Jonathan Hodgkinson4 · Cosimo Alex Leo3,4 Received: 24 May 2020 / Accepted: 18 June 2020 © The Author(s) 2020
Abstract Background In March, 2020, the World Health Organization declared COVID-19 a pandemic. The absence of previous knowledge of COVID-19 has made decision-making difficult for all in health care, including surgical departments. We reviewed the management recommendations for surgical activity and changes to surgical practice, identifying concordances and discrepancies, based on the literature published in the early phase of the pandemic. Method We searched the electronic datasets, PubMed Database, Google, and Google Scholar, using the keywords “SARSCoV-2”, “COVID-19”, “surgery”, “recommendations”, “guideline”, and “triage”. The search was limited to the first 2 months after the pandemic began and was closed on May 6, 2020. Results Twenty papers were included in the analysis and their recommendations are divided into the following categories: 1. general aspects, such as maintaining the safety of health personnel and indications for surgery. 2. The preoperative phase, with recommendations about activating different care pathways for COVID-19 positive patients. 3. The operative phase, with recommendations about activating safety measures for aerosol-generating procedures. 4. The postoperative phase, with recommendations for managing operating theatres and patient transfers. Conclusion The recommendations proposed in the revised documents are considered good practices aimed at keeping patients and healthcare professionals safe. However, these recommendations must be contextualized in each individual hospital. Keywords SARS-CoV-2 · COVID-19 · Surgery · Management · Recommendations
The scenario On December 31, 2019, Chinese health authorities reported an outbreak of pneumonia of unknown etiology in Wuhan City, Hubei Province, China [1,2]. On January 9, 2020, the * Vittorio Bresadola [email protected] 1
General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
2
Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
3
Department of General and Emergency Surgery, Northwick Park and St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
4
Department of Surgery & Cancer, Imperial College London, London, UK
China Centre for Disease Control identified the causative agent as a new coronavirus called 2019-nCOV (officially SARS-CoV-2) [3,4]. On February 11, 2020, the World Health Organization (WHO) named the respiratory disease related to infection “COVID-19” (Corona Virus Disease) [5]. On March 11, 2020, the WHO declared the COVID-19 outbreak a pandemic [6]. In Italy, the first western country massively aff
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