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New Guidance for Perioperative Management of COVID-19 Patients

The Surgical Infection Society (SIS) announces the publication of two guidance documents (1, 2) of value to the perioperative services community.

Frontline health care workers are at high risk of viral transmission from COVID-19 patients. Risk mitigation is the responsibility of individual personnel and hospital systems, and it must occur at every stage along the continuum of patient care, from transport to the pre-operative holding area; through the operating room (OR), postoperative care, and discharge. Paramount among these mitigation tactics are social distancing; frequent hand washing; and diligent, meticulous use of personal protective equipment, including N-95 masks, goggles, and powered air-purifying respirators in high-risk situations. The SIS also recommends ongoing reevaluation of local protocols and procedures to remain current with newer data and evolving guidelines.

In order to manage the several waves of the surge of COVID-19 patients, facilities often had to curtail or cease doing elective surgery, resulting in a large backlog of patients worldwide — numbering in the millions — in need of surgical care.  Many other patients who would normally have undergone urgent or emergency surgery such as appendectomy or cholecystectomy were managed non-operatively, as scarce OR time was allocated to bona fide emergencies. The guidance summarizes current knowledge about surgical risks and outcomes of emergency operations on COVID-19 patients, the magnitude of the backlog, and logistics for resumption of surgical services in a rational, equitable manner, including organizational considerations, resource utilization, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs. Resumption requires institutional commitment and integrated teams working together. Continued vigilance and protection of patients and staff remain paramount.

1. Heffernan DS, Evans HL, Huston JM, et al. Surgical Infection Society guidance for operative and peri-operative care of adult patients infected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Surg Infect (Larchmt) 2020;21:301-308.

2. Barie PS, Ho VP, Hunter CJ, et al. Surgical Infection Society guidance for restoration of surgical services during the coronavirus disease-2019 pandemic. Surg Infect (Larchmt) 2021 Feb 25. doi: 10.1089/sur.2020.421. [Online ahead of print].

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