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Framework for prioritizing head and neck surgery during the COVID-19 pandemic
Michael C Topf1, Jared A Shenson1, F Christopher Holsinger1
1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA.
Head & Neck
|April 17, 2020
Summary
This commentary offers a framework for prioritizing head and neck surgeries during the COVID-19 pandemic. It addresses unique patient risks and outlines criteria for delaying or proceeding with procedures.
Area of Science:
- Health Care Management
- Surgical Prioritization
- Pandemic Response
Background:
- The COVID-19 pandemic significantly strained the US healthcare system, leading to cancellations of elective procedures.
- Existing definitions for elective and urgent surgeries allow for surgeon discretion in case designation.
- Head and neck surgery presents unique challenges during pandemics due to oncology patient risks and transmission concerns.
Purpose of the Study:
- To provide a framework for prioritizing head and neck surgery cases during the COVID-19 pandemic.
- To examine specific considerations for head and neck patients, including oncologic outcomes and transmission risks.
- To discuss strategies for mitigating transmission during otolaryngologic procedures.
Main Methods:
- Development of a case prioritization framework with four categories: urgent, postpone >30 days, postpone 30-90 days, and case-by-case.
- Examination of unique risks for head and neck cancer patients regarding treatment delay.
- Discussion of a preoperative clinical pathway for transmission mitigation, including risk stratification of surgeries and COVID-19 testing.
Main Results:
- A structured approach to prioritizing head and neck surgeries during a pandemic is proposed.
- The framework categorizes cases based on urgency and potential outcomes following delayed treatment.
- Preoperative strategies for transmission mitigation, including identifying high-risk procedures, are outlined.
Conclusions:
- A systematic approach is crucial for managing head and neck surgery during public health crises like the COVID-19 pandemic.
- Prioritization must consider oncologic outcomes, patient-specific risks, and surgical transmission potential.
- Preoperative pathways and testing are vital for patient safety and resource conservation.
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