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Consensus-based perioperative protocols during the COVID-19 pandemic.

Praveen V Mummaneni1, John F Burke1, Andrew K Chan1

  • 1Departments of1Neurological Surgery.

Journal of Neurosurgery. Spine
|October 2, 2020
PubMed
Summary

Healthcare facilities developed consensus-based perioperative protocols for urgent procedures during the COVID-19 pandemic. These guidelines help optimize patient care amidst resource constraints.

Keywords:
COVID-19coronavirus disease 19infectionperioperative caresurgical triage

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Area of Science:

  • Medicine
  • Healthcare Management
  • Infectious Diseases

Background:

  • The COVID-19 pandemic necessitated adaptations in healthcare delivery, particularly for patients requiring urgent and emergent invasive procedures.
  • Quaternary-care facilities faced capacity and resource constraints while maintaining essential surgical services.

Purpose of the Study:

  • To develop consensus-based perioperative protocols for managing patients undergoing urgent/emergent invasive procedures during the COVID-19 pandemic.
  • To streamline care and optimize resource allocation in a high-acuity surgical setting.

Main Methods:

  • A multidisciplinary panel of 26 leaders from various departments, including clinical and administrative roles, was assembled.
  • A modified two-round, blinded Delphi method was employed to achieve consensus on 18 agree/disagree statements.
  • Consensus was statistically tested, and final protocols were developed through unblinded group discussions.

Main Results:

  • Consensus was achieved on 15 of 18 statements in the first round; 3 required modification and re-submission.
  • Developed protocols included quantifying outbreak levels, patient triage by acuity, and a checklist for invasive procedures.
  • A novel scoring system for personal protective equipment (PPE) allocation was created, adapting existing triage systems for neurosurgery and spine surgery.

Conclusions:

  • Consensus-based protocols can assist healthcare providers in optimizing perioperative care during the COVID-19 pandemic.
  • These protocols address the unique challenges of performing urgent/emergent procedures under pandemic conditions.
  • The developed algorithms provide a framework for structured decision-making in resource-limited environments.