Derleme
The Fact of Sars-CoV-2 (COVID-19) and Current Surgical Approach Recommendations of Zonguldak Bulent Ecevit University The School of Medicine General Surgery Department During Pandemic
Öz
The accelerating case numbers of COVID-19 in Asia, Europe and America obliged us to take strict precautions in order to restrain
community transmission in hospitals where diagnosis, treatment and management are actively performed. Turkish Ministry of Health
issued a circular on time to stop all elective procedures, but emergency and oncologic cases. During COVID-19 pandemic, we,
as surgeons take the responsibility to assist caring infected patients, in addition to perform emergency surgery and operate on
oncologic cases for whom deferring surgery has a negative impact on prognosis. Surgical interventions are the basic community
health services categorized as elective and emergent. Operating theaters are the places with high risk of transmission of respiratory
infections due to emergencies, high volume of personnel, and airway procedures to be done. Our institutes and systems are very
well prepared to usual high-risk transmission status. However, in extraordinary circumstances like pandemics, high prevalence
of disease and limited resources led to great pressure over surgical and operative team which has the potential to increase the
system load and tendency to make mistakes. Accordingly, our primary mission is to act immediately to protect our team and patients
via preserving and appropriately utilizing valuable resources in order to maintain surgical functioning in terms of emergency. The
priority should be to design our surgical approach dynamically in regard to the COVID-19 status and resources of the facility we are
working in. We, Zonguldak Bülent Ecevit University The School of Medicine Department of General Surgery aimed to redesign our
surgical algorithms during Covid-19 pandemic according to Turkish Ministry of Health circular and experiences of our colleagues and
recommendations of the international surgical societies guidelines. To share our experiences, practices and recommendations is out
most important in these days during which we do not have enough time to wait for the data with high level of evidence. Surgeons
should pay great attention on their facility’s COVID-19 status and resources before surgical decision making to establish best clinical
practice and save patients’ lives during these unprecedented period of time.
Kaynakça
- 1. Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States. Centers for Disease Control and Protection. Published 29th Feb, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html
- 2. COVID-19: Elective Case Triage Guidelines for Surgical Care Up Online March 24, 2020, FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case
- 3. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations
- 4. Create a Surgical Review Committee for COVID-19-Related Surgical Triage Decision Making, Online March 24, 2020. Developed by the American College of Surgeons, American Society of Anesthesiologists, and Association of periOperative Registered Nurses FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/review-committee
- 5. COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures, Online March 17, 2020. FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/triage
- 6. COVID-19 Guidelines for Triage of Cancer Surgery Patients.Online March 24, 2020.FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case/cancer-surgery
- 7. COVID-19 Guidelines for Triage of Breast Cancer Patients.Online March 24, 2020. https://www.facs.org/covid-19/clinical-guidance/elective-case/breast-cancer
- 8. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary Version 1.0 The COVID-19 Pandemic Breast Cancer Consortium. March 24, 2020. https://www.breastsurgeons.org/docs/news/The_COVID
- 9. Ontario Health, Cancer Care Ontario, “Pandemic Planning Clinical Guideline for Patients with Cancer”, https://www.accc-cancer.org/docs/document/cancer-program-fundamentals/oh-ccopandemic-planning-clinical-guidelines (accessed March 23, 2020)
- 10. Resource for Management Options of Breast Cancer During COVID-19 March 23, 2020, Society of Surgiacal Oncology. https://www.surgonc.org/wp-content/uploads/2020/03/Breast-Resource-during-COVID-19-3.23.20.pdf
- 11. Statement on COVID-19. Advice for Surgical Oncologists on Cancer Service Provision. 27th March, 2020 European Society of Surgical Oncology. https://www.essoweb.org/news/esso-statement-covid-19/
- 12. Guidance for surgeons working during the COVID-19 pandemic. Royal Collage of Surgeons, 20 March 2020. https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/
- 13. COVID-19 Patient Care Information. 13 March 2020. https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19
- 14. SAGES Recommendations Regarding Surgical Response to COVID-19 Crisis March 19, 2020 by Julie Miller. Available at: https://www.sages.org/recommendations-surgical-response-covid-19/
- 15. Experimental study of the potential hazards of surgical smoke from powered instruments. In SM, Park DY, Sohn IK, et al. Br J Surg. 2015, 102:1581––1586.
- 16. Studies on the transmission of viral disease via the CO2 laser plume and ejecta. Wisniewski PM, Warhol MJ, Rando RF, Sedlacek TV, Kemp JE, Fisher JC. J Reprod Med. 1990, 35:1117–23.
Sars-CoV-2 (COVID-19) Gerçeği ve Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı Pandemi Sürecinde Güncel Cerrahi Yaklaşım Önerileri
Öz
COVID-19, Asya, Avrupa ve Amerika kıtasında yüksek ivme ile yayılırken, özellikle hastaneler
hastalığın tedavisi ve yayılımı konusunda en aktif noktalar olup topluma transmisyonun artmaması
adına katı tedbirlerin alınması gerekliliği ortaya çıktı. Türkiye’de Sağlık Bakanlığı genelgesi ile
acil ve ertelenemeyecek onkolojik vakalar dışında tüm elektif cerrahi müdahalalerin durdurulması
sağlandı. Bu pandemi sürecinde cerrahlar olarak enfekte hastaları iyileştirmeye yardım etmenin
yanısıra cerrahiyi ertelemenin prognozu etkileyecek hastalar ile acil cerrahi uyguladığımız hastalarımızın
sorumluluğunu almakla yükümlüyüz. Cerrahi girişimler elektif ve acil girişimler şeklinde
tüm sağlık sistemleri içinde yer alan temel toplum sağlığı hizmetleridir. Ancak, ameliyathaneler
acil durumlar, çok sayıda ekip elemanının görev alması ve havayolu müdahalesi gibi yüksek
transmisyon riskine sahip aktiviteler sebebi ile solunum yolu enfeksiyonlarının yayılımı açısından
yüksek risk bölgeleridir. Hastanelerimiz ve sistemlerimiz olağan, yüksek riskli transmisyon durumları
için oldukça iyi şekilde organize edilmiş olmasına karşın, pandemi durumları gibi hastalık
prevelansının yüksek, kaynak kısıtlılıklarının olası, ekip üzerindeki baskı ve basıncın fazla olduğu
durumlar transmisyon riskini yükselterek sistemin zaten ağır olan yükünü artırma potansiyeli taşımaktadır.
Bu nedenle görevimiz hemen harekete geçerek değerli kaynaklar ile hasta ve ekibimizi
koruyarak sistemimizin elzem cerrahi girişimlere destek verebilmesini sağlamaktır. Tüm zorluklara
rağmen dünya genelinde meslektaşlarımızın tecrübelerinden de faydalanarak pandemi süresince
kurumumuzun COVID-19 statüsü ve kaynaklarını rasyonel ve dinamik şekilde dikkate alıp cerrahi
yaklaşımımızı planlamak önceliğimiz olmalıdır. Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi
Genel Cerrahi Anabilim Dalı olarak pandemi süresince uygulayacağımız cerrahi yönetim planımızı
Sağlık Bakanlığımız genelgesi doğrultusunda Amerika Birleşik Devletleri, Avrupa ve Asya’da
pandeminin hızla yayıldığı ülkelerin cerrahi dernek önerilerini dikkate alarak dizayn etmeyi amaçladık.
Hekimler olarak deneyim, uygulama ve önerilerimizi paylaşmamız yüksek kanıt düzeyine
sahip verileri bekleme şansımızın olmadığı bu süreçte, hastanemizin COVID-19 durumunu ve
kaynak miktarını göz önünde bulundurarak hastalarımıza yarar sağlayacak en iyi uygulamaların
kullanıma girmesi ve hayatların kurtarılması adına büyük önem taşımaktadır
Kaynakça
- 1. Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States. Centers for Disease Control and Protection. Published 29th Feb, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html
- 2. COVID-19: Elective Case Triage Guidelines for Surgical Care Up Online March 24, 2020, FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case
- 3. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations
- 4. Create a Surgical Review Committee for COVID-19-Related Surgical Triage Decision Making, Online March 24, 2020. Developed by the American College of Surgeons, American Society of Anesthesiologists, and Association of periOperative Registered Nurses FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/review-committee
- 5. COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures, Online March 17, 2020. FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/triage
- 6. COVID-19 Guidelines for Triage of Cancer Surgery Patients.Online March 24, 2020.FACS Bulletin: COVID-19 Surgery Information and Resources. https://www.facs.org/covid-19/clinical-guidance/elective-case/cancer-surgery
- 7. COVID-19 Guidelines for Triage of Breast Cancer Patients.Online March 24, 2020. https://www.facs.org/covid-19/clinical-guidance/elective-case/breast-cancer
- 8. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary Version 1.0 The COVID-19 Pandemic Breast Cancer Consortium. March 24, 2020. https://www.breastsurgeons.org/docs/news/The_COVID
- 9. Ontario Health, Cancer Care Ontario, “Pandemic Planning Clinical Guideline for Patients with Cancer”, https://www.accc-cancer.org/docs/document/cancer-program-fundamentals/oh-ccopandemic-planning-clinical-guidelines (accessed March 23, 2020)
- 10. Resource for Management Options of Breast Cancer During COVID-19 March 23, 2020, Society of Surgiacal Oncology. https://www.surgonc.org/wp-content/uploads/2020/03/Breast-Resource-during-COVID-19-3.23.20.pdf
- 11. Statement on COVID-19. Advice for Surgical Oncologists on Cancer Service Provision. 27th March, 2020 European Society of Surgical Oncology. https://www.essoweb.org/news/esso-statement-covid-19/
- 12. Guidance for surgeons working during the COVID-19 pandemic. Royal Collage of Surgeons, 20 March 2020. https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/
- 13. COVID-19 Patient Care Information. 13 March 2020. https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19
- 14. SAGES Recommendations Regarding Surgical Response to COVID-19 Crisis March 19, 2020 by Julie Miller. Available at: https://www.sages.org/recommendations-surgical-response-covid-19/
- 15. Experimental study of the potential hazards of surgical smoke from powered instruments. In SM, Park DY, Sohn IK, et al. Br J Surg. 2015, 102:1581––1586.
- 16. Studies on the transmission of viral disease via the CO2 laser plume and ejecta. Wisniewski PM, Warhol MJ, Rando RF, Sedlacek TV, Kemp JE, Fisher JC. J Reprod Med. 1990, 35:1117–23.
Toplam 16 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Derleme |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2020 |
| Kabul Tarihi | 29 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 4 Sayı: 1 |
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