New Study Provides Surgery Guidelines During COVID-19 Pandemic

The International Consensus Group (ICM) recently released guidelines titled “Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic.”

The guidelines appear in The Journal of Bone & Joint Surgery, published in the Lippincott portfolio in partnership with Wolters Kluwer. The authors include: Javad Parvizi, M.D., FRCS; Thorsten Gehrke, M.D.; Chad Krueger, M.D.; Emanuele Chisari, M.D.; Mustafa Citak, M.D., Ph.D.; Stefaan Van Onsem, M.D., Ph.D.; Bill Walter, MBBS, Ph.D.; the ICM; and Research Committee of the American Association of Hip and Knee Surgeons (AAHKS).

Orthopedic surgical procedures have been cancelled or delayed since the start of the COVID-19 pandemic. As restrictions ease and surgeries begin to resume, the panel issued recommendations to minimize the risk of spreading COVID-19.

The guidelines were developed using the Delphi method with input from 77 physicians across various specialties including orthopedic surgery, infectious disease, microbiology and virology, and anesthesia. The study presents a set of 30 recommendations in four categories: general, preoperative, intraoperative, and postoperative.

In the general category, a majority of the group agreed regarding when elective surgeries may be resumed. Specifically, when lockdown is lifted, facilities have adequate personal protective equipment, and facilities can keep non-COVID-19 patients separate from COVID-19-positive patients. The group also agreed that patients who are currently infected with COVID-19 “should not undergo elective surgery.”

Preoperative questions focused on the pre-admission process and testing. The group provided a long list of additional steps to take during the pre-admission process for patients undergoing elective surgery during the COVID-19 pandemic. Steps include wearing a mask and general social distancing principles. The group strongly recommended that testing for COVID-19 be mandatory in high-prevalence areas for patients undergoing elective surgery.

Intraoperative questions and guidelines focused on the sterilization of the operating room and protecting surgeons, patients, and assistants. It recommended that operative staff take a number of precautions including “limiting the number of people in the operating room” and “keeping equipment in the room to a minimum.”

Postoperative questions and guidelines provided insight on what to do regarding patient recovery and care. This included what to do if a patient tests positive for COVID-19 in the postoperative period. During the COVID-19 pandemic, it advised that all patients wear a surgical mask in the postoperative period. The study also recommended that facilities limit patient stay in the recovery area “while maintaining perioperative safety.” Further, it encouraged follow-up to be done by telemedicine.

The study is limited as knowledge surrounding COVID-19 continues to evolve. The panel acknowledged that the recommendations may change or even reverse “as further evidence emerges.” Further, the guidelines are “not meant to be strictly enforced but rather to serve as a resource for surgeons, staff, and administrators.”