Ann Surg 2020 Dec 29. Epub 2020 Dec 29.
*Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA †Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy ‡Department of Surgery, Southampton University Hospital., 1. Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA §Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA ¶Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands ||Department of Surgery, Trinity College Dublin, and St. Vincent's University Hospital, Dublin, Ireland **Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland ††Edward W. Archibald Professor and Chair, Department of Surgery McGill University Surgeon-in-chief, McGill University Health Centre Montreal, Quebec, Canada ‡‡University Hospital Virgen del Rocio, Sevilla, Spain §§Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università Degli Studi Di Pavia, Pavia, Italy. Fondazione IRCCS Policlinico San Matteo, Pavia ¶¶Stony Brook University Department of Surgery, Stony Brook, NY, USA ||||Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada ***Icahn School Medicine at Mount Sinai, New York, NY, USA †††Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain ‡‡‡Ministry of Health, Madrid, Spain §§§Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA ¶¶¶Department of Surgery, Mayo Clinic, Rochester, MN, USA ||||||Department of Anesthesia at Baptist Hospital of Miami, Miami, FL, USA. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA ****General Management, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ††††BA Wake Forest University, Reno, NV, USA ‡‡‡‡Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea. 16. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA §§§§Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA ¶¶¶¶Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland ||||||||Department of Surgery, Massachusetts General Hospital, Boston, USA *****Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore †††††Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA ‡‡‡‡‡Divisions of General and Gastrointestinal Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA §§§§§Southern Illinois University School of Medicine, Departments of Surgery and Medical Education, Springfield, IL, USA ¶¶¶¶¶Division of General Surgery, Department of Surgery, Montefiore Medical Center, New York, NY, USA ||||||||||Department of Surgery, ABC Medical Center, Mexico City, Mexico ******Servicio de Cirugía Endoscópica Hospital San Borja Arriarán de Santiago. Departamento de Cirugía, Clinica Santa Maria, Santiago, Chile ††††††Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA ‡‡‡‡‡‡Department of Digestive Surgery, Nouvel Hôpital Civil, Université de Strasbourg, IHU Institute of Image-Guided Surgery of Strasbourg and U1110 Inserm, Institute of Viral and Liver Disease, Strasbourg, France §§§§§§Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy. Department of Woman and Child Health and Public Health - Public Health Area Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy ¶¶¶¶¶¶Department of Surgery, University at Buffalo, Buffalo, NY, USA ||||||||||||Department of Surgery, NYU Langone Health, New York, NY, USA *******Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA †††††††Departments of Surgery, State University of New York, Stony Brook, NY, USA ‡‡‡‡‡‡‡Departamento of Surgery, Hospital Escuela "José de San Martín", Corrientes, Argentina.**, 2. Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy §§§§§§§Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ¶¶¶¶¶¶¶Fondazione Nadia Valsecchi Onlus, Palazzolo Sull'Oglio, Brescia, Italy ||||||||||||||Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA ********Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA ††††††††Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA ‡‡‡‡‡‡‡‡Miami Cancer Institute, Miami, FL, USA §§§§§§§§Department of General Surgery, Yeovil District Hospital National Health Service Foundation Trust, Yeovil, England. Division of Surgery and Interventional Science, University College London. The Griffin Institute at Northwick Park Institute for Medical Research, Norwich Park London. Enhanced-Recovery After Surgery - UK (ERAS-UK).
Objective: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities.
Background: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative (CVGSC) sought to formulate, through rigorous scientific methodology, a consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policy makers.
Methods: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across four continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in two rounds, as well as in a telepresence meeting.
Results: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eightythree of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of five other statements.
Conclusions: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.