Guidelines for Resuming Elective Hip and Knee Surgical Activity Following the COVID-19 Pandemic: An Italian Perspective
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RESPONSE TO COVID-19/COMMENTARY
Guidelines for Resuming Elective Hip and Knee Surgical Activity Following the COVID-19 Pandemic: An Italian Perspective Riccardo D’Ambrosi, MD & Alessio Biazzo, MD & Francesco Masia, MD & Vincenzo Izzo, MD & Norberto Confalonieri, MD & Nicola Ursino, MD & Francesco Verde, MD
Received: 17 June 2020/Accepted: 17 September 2020/ * Hospital for Special Surgery 2020
Keywords pandemic . COVID-19 . SARS-CoV-2 . arthroplasty . elective surgery . hip and knee
Introduction At our institution in Italy, we developed a protocol to establish treatment recommendations for patients with orthopedic pathology who needed surgery during the COVID-19 pandemic. Our purpose was to guarantee safety for patients, staff, and facility. It is important to keep in mind that a peri-operative SARS-CoV-2 infection could result in higher complication rates for patients with comorbidities [13]. We developed the following critical principles in caring orthopedic patients during the pandemic: 1. Prevent people with asymptomatic SARS-CoV-2 infection from accessing the hospital and consequently prevent outbreaks on the units. 2. Create COVID-19-free environments within the hospital; separate these units from those where patients with COVID-19 are treated. 3. Reduce the risk of contagion in operating rooms. 4. Reduce hospitalization days to the minimum for patients undergoing essential orthopedic surgery. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09809-w) contains supplementary material, which is available to authorized users. R. D’Ambrosi, MD (*) : N. Ursino, MD IRCCS Istituto Ortopedico Galeazzi, Milan, Italy e-mail: [email protected] A. Biazzo, MD : F. Masia, MD : V. Izzo, MD : N. Confalonieri, MD : F. Verde, MD Hip and Knee Reconstructive Surgery Department, Humanitas Gavazzeni, Bergamo, Italy
5. Select patients carefully as candidates for surgery during this period of increased risk. Our protocol included the following adaptations of our normal processes. 1. Facility requirement: All diagnosis and treatment activities related to surgery for patients not infected with SARS-CoV-2 must be performed in a COVID-19-free environment. 2. Healthcare staff requirements: Ideally, all staff involved in the management of patient candidates for elective orthopedic surgery should be tested for SARS-CoV-2. Furthermore, all staff should be regularly monitored for infection with checks on a weekly or bi-weekly basis. 3. Patient selection: Patient selection must take into account age, urgency of treatment, risk of exposure to SARS-CoV2, American Society of Anesthesiologists (ASA) classification, comorbidity, socio-professional situation, and the possibility of performing post-operative physiotherapy [7, 13]. To screen patients for exposure to SARS-CoV-2 prior to surgery, we assumed six categories in accordance with Feinberg [4] (Table 1). 1. Patients not known to be exposed or infected. Prior to elective surgery, these patients were assessed with a 48to 72-h
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