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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 May; 21(4):301-308.SI

Abstract

Background:

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected.

Methods:

Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients.

Results:

COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers.

Conclusions:

This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.

Authors+Show Affiliations

Department of Surgery, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA. Division of Trauma and Surgical Critical Care, Department of Surgery, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA.Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.Departments of Surgery and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.Division of Trauma, Critical Care, Burns & Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.Department of Surgery, Division of Trauma/Surgical Critical Care, Inova Medical Group, Inova Fairfax Medical Campus, Falls Church, Virginia, USA. Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, Maryland, USA.Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA.Division of General Surgery/Critical Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA. Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA.Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Society of Critical Care Medicine, Mount Prospect, Illinois, USA.

Pub Type(s)

Journal Article
Practice Guideline
Review

Language

eng

PubMed ID

32310715

Citation

Heffernan, Daithi S., 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)." Surgical Infections, vol. 21, no. 4, 2020, pp. 301-308.
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(4):301-308.
Heffernan, D. S., Evans, H. L., Huston, J. M., Claridge, J. A., Blake, D. P., May, A. K., Beilman, G. S., Barie, P. S., & Kaplan, L. J. (2020). 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). Surgical Infections, 21(4), 301-308. https://doi.org/10.1089/sur.2020.101
Heffernan DS, 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(4):301-308. PubMed PMID: 32310715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Heffernan,Daithi S, AU - Evans,Heather L, AU - Huston,Jared M, AU - Claridge,Jeffrey A, AU - Blake,David P, AU - May,Addison K, AU - Beilman,Greg S, AU - Barie,Philip S, AU - Kaplan,Lewis J, Y1 - 2020/04/20/ PY - 2020/4/21/pubmed PY - 2020/5/7/medline PY - 2020/4/21/entrez KW - COVID-19 KW - SARS-CoV-2 KW - SIS KW - guidelines KW - pandemic KW - virus infection SP - 301 EP - 308 JF - Surgical infections JO - Surg Infect (Larchmt) VL - 21 IS - 4 N2 - Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care. SN - 1557-8674 UR - https://www.unboundmedicine.com/medline/citation/32310715/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__ L2 - https://www.liebertpub.com/doi/10.1089/sur.2020.101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -