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Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via
Kimberly-Anne Tan1, Vishaal Nanik Thadani1, Daniel Chan2
1University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore.
Insights
Spine surgeons developed consensus guidelines for patient care during the COVID-19 pandemic. Preoperative testing was recommended to protect healthcare workers and patients, ensuring continuity of spine services.
Area of Science:
- Orthopedics
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic presents unprecedented challenges for healthcare providers, particularly in specialized surgical fields.
- Filtering relevant information for clinical practice during the pandemic is difficult for physicians.
- The Spine Society of Singapore convened experts to address pandemic-related issues in spine surgery.
Purpose of the Study:
- To establish a national consensus on managing spine services during the COVID-19 pandemic.
- To develop guidelines for adapting spine surgery practices to the crisis.
- To share collective wisdom and best practices among spine surgeons.
Main Methods:
- A teleconference was held with 13 spine surgeons from Singapore on April 24, 2020.
- Discussions covered surgeon roles, service continuity, telemedicine, triage, preoperative testing, surgical challenges, and post-pandemic preparation.
- The Delphi panel method was used to reach consensus on specific issues, including triage guidelines and preoperative testing.
Main Results:
- Consensus was reached on repurposing surgeons, maintaining spine service continuity, and implementing telemedicine.
- New triage guidelines for spinal surgeries were established.
- The panel voted in favor of routine preoperative testing to safeguard healthcare professionals and patients.
Conclusions:
- A rapid consensus was achieved, strengthening national efforts to maintain high standards of spine care during the pandemic.
- The established guidelines provide a framework for addressing COVID-19 in spine surgery.
- Similar discussions are encouraged for other national and regional societies to navigate the pandemic effectively.
Abstract:
The magnitude and potential duration of the current coronavirus disease 2019 (COVID-19) pandemic is something that most doctors currently in practice have yet to experience. While considerable information regarding COVID-19 is being published every day, it is challenging to filter out the most relevant or appropriate information for our individual practice. The Spine Society of Singapore convened via a teleconference on April 24, 2020 to collaborate on a national level and share collective wisdom in order to tackle the ongoing crisis. In the teleconference, 13 spine surgeons from across various hospitals in Singapore constituted the panel of experts. The following topics were discussed: repurposing of surgeons, continuity of spine services, introduction of telemedicine, triaging of spinal surgeries, preoperative testing, new challenges in performing spine surgery, and preparing for the post-pandemic era. While some issues required only the sharing of best practices, the Delphi panel method was adopted to form a consensus on others. Existing spine specific triage guidelines were debated and a locally accepted set of guidelines was established. Although preoperative testing is currently not performed routinely, the panel voted in favor of its implementation because they concluded that it is vital to protect themselves, their colleagues, and their patients. Solutions to operating room specific concerns were also discussed. This article reflects the opinions and insights shared during this meeting and reviews the evidence relevant to the issues that were raised. The rapid consensus reached during the teleconference has enabled us to be concerted, and thus stronger, in our national efforts to provide the best standard of care via our spine services in these challenging times. We believe that this article will provide some guidance for addressing COVID-19 in spine surgery and encourage other national/regional societies to conduct similar discussions that would help their navigation of this pandemic.
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