- Facilities that perform elective surgical procedures should open and start providing procedures only when COVID-19 is adequately under control in their area and enough PPE is available for all physicians and staff to be properly protected
- Patients with active COVID-19 should not undergo elective surgical procedures
- Patients should be properly educated on the procedures which they will undergo as well as COVID-19 prevention methods available at said facility in order for all parties to be as safe as possible


Ohio State University, Columbus

- This article provides a question-and-answer type format to assist with the creation of guidelines for facilities that perform elective surgical procedures
- The questions posed in this article are broken up into 4 sections comprised of general questions, preoperative questions, intraoperative questions, and postoperative questions
- The authors also state that even though they have posed many questions in order to answer and provide guidance in many facets of care, they cannot predict all questions and facilities will need to establish guidelines specifically to fit their needs
- Lastly, each question was answered by a group of 77 physicians which was then voted on by a group of delegates to make sure all answers were encompassing and accurate
- The child nodes regarding this paper will not be posing each question as there are many, but will instead attempt to provide a summary of the information provided under the questions and answers in each section

Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic

Parvizi, J., Gehrke, T., Krueger, C. A., Chisari, E., Citak, M., Van Onsem, S., Walter, W. L., & International Consensus Group (ICM) and Research Committee of the American Association of Hip and Knee Surgeons (AAHKS) (2020). Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic: Guidelines Developed by the International Consensus Group (ICM). The Journal of bone and joint surgery. American volume, 102(14), 1205–1212. https://doi.org/10.2106/JBJS.20.00844

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431146/


General Questions

- During the proadministration process, patients should now provide or receive the following information and general care:
     - Questioning regarding travel, occupation, contact, and cluster
     - A recent COVID-19 test and its results
     - Avoidance of patient interaction with staff and other possible infected individuals at facility during check in, waiting for appointment, and visitation
     - Patients should be housed in single rooms
     - Large surgical bays should be refrained from use
- Patients with negative COVID-19 tests but affirmative symptoms should receive repeat testing as well as a chest CT scan in order to find lung abnormalities


Preoperative Questions

- There should be greater air circulation within the operating room as well as a minimization of equipment and people to limit possible infection
- It is highly recommended that all people present performing the surgical procedure do so with N95 level face masks as well as face shield protection
- Regional anesthesia is highly recommended in order to limit the use of anesthesia which requires the use of an airway
- The use of multiple operating rooms is preferred as it would allow for optimal cleaning of each room
- The use of nonabsorbable stitches and staples should be deterred as they require additional staff contact with the patient


Interoperative Questions

- Unprotected staff come into contact with a patient who post-surgery tests positive for COVID-19 should be tested for COVID-19 and quarantined until negative result comes back
- In the post anesthesia recovery unit, patients should be spaced 6 feet, patient time in recovery room should be minimized, patients who couldn’t be extubated should be transferred to ICU, and the use of a separate PACU should be considered for non-COVID-19 cases and short stay individuals
- The use of NSAIDs on patients for recovery is preferred as long as they are not infected with COVID-19


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