a protocol for fast tracked foregut surgery in response to the COVID 19 pandemic
Fast-tracked foregut surgery protocols were developed in response to the COVID-19 pandemic to minimize the risk of viral transmission while ensuring timely and necessary surgical care. These protocols aimed to streamline patient management, optimize safety measures, and prioritize urgent cases. While specific protocols may vary between institutions, here are some general components that could be included:
- Preoperative Assessment: a. Risk stratification: Identify patients who require urgent foregut surgery based on clinical presentation, severity of symptoms, and underlying conditions. b. COVID-19 screening: Implement screening measures, such as symptom questionnaires and testing, to identify potential COVID-19 cases before surgery. c. Telemedicine: Utilize telemedicine platforms to conduct preoperative evaluations, reduce in-person visits, and provide preoperative education.
- Preoperative Preparation: a. Isolation and testing: If COVID-19 screening is positive or suspected, follow institutional guidelines for isolation and testing protocols. b. Optimization of comorbidities: Manage and optimize any preexisting medical conditions to minimize surgical risks. c. Consent process: Provide comprehensive informed consent, discussing the risks, benefits, and potential modifications to surgical care in the context of the pandemic.
- Surgical Workflow: a. Personal Protective Equipment (PPE): Ensure adequate availability and proper use of PPE for the surgical team. b. Operating room considerations: Implement infection prevention measures, including enhanced cleaning protocols, proper ventilation, and reduced personnel in the operating room. c. Minimally invasive approaches: Consider laparoscopic or robotic-assisted techniques when appropriate, as they may reduce hospital stay and postoperative complications.
- Postoperative Care: a. Enhanced recovery protocols: Utilize evidence-based enhanced recovery after surgery (ERAS) protocols to promote faster recovery, reduce hospital stay, and minimize postoperative complications. b. Discharge planning: Develop streamlined discharge protocols to facilitate timely and safe discharge from the hospital, while ensuring appropriate follow-up care.
- Follow-up and Monitoring: a. Virtual follow-up visits: Conduct virtual follow-up visits whenever possible to minimize in-person clinic visits. b. Symptom monitoring: Educate patients about postoperative symptoms to monitor for potential complications and provide clear instructions for seeking medical attention if needed.
It’s important to note that these protocols should be developed and implemented in collaboration with multidisciplinary teams, including surgeons, anesthesiologists, infectious disease specialists, and hospital administrators. They should align with the local and national guidelines and be adapted based on the evolving understanding of COVID-19 and its impact on surgical care.
For specific information and guidance regarding fast-tracked foregut surgery protocols during the COVID-19 pandemic, it is recommended to consult with local healthcare authorities, professional surgical societies, and relevant published literature.