American College of Surgeons releases new clinical guidance
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The Coronavirus Disease 2019 (COVID-19) outbreak continues to challenge. Expert projections estimate that despite social distancing being practiced (albeit suboptimally in certain places), we have yet to feel the full impact of COVID-19.

The American College of Surgeons continues to provide guidance for surgeons to curtail recommendations for elective surgical procedures to preserve the necessary resources for the care of critically ill patients during the COVID-19 pandemic.

To assist in surgical decision-making in curtailing cases, ACS has released “COVID-19: Elective Case Triage Guidelines for Surgical Care,” a new surgical triage document that was developed following an expert review in several specialties and provides trusted information.

Key recommendations :

-Be aware that while some of the following triaging guidelines include a “Level 1” (e.g., lowest level of COVID-19 acuity) in the recommendations, one must be aware that the rates of COVID-19 are predicted to skyrocket in the next few weeks, and the overarching recommendation is to prepare for markedly increased rates when triaging elective cases at present.

-Patients should receive appropriate and timely surgical care, including operative management, based on sound surgical judgment and availability of resources.

-Consider nonoperative management whenever it is clinically appropriate for the patient.

-Consider waiting on results of COVID-19 testing in patients who may be infected.

-Avoid emergency surgical procedures at night when possible due to limited team staffing.

-Aerosol generating procedures (AGPs) increase the risk to the health care worker but may not be avoidable. For patients who are or may be infected, AGPs should only be performed while wearing full PPE including an N95 mask or powered, air-purifying respirator (PAPR) that has been designed for the OR. Examples of known and possible AGPs include:
-Intubation, extubation, bag masking, bronchoscopy, chest tubes
-Electrocautery of blood, gastrointestinal tissue, any body fluids

-There is insufficient data to recommend for/against an open versus laparoscopic approach; however, the surgical team should choose an approach that minimizes OR time and maximizes safety for both patients and healthcare staff. Refer to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines for these patients.

About the American College of Surgeons:

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery.

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

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