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The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper

  • De Simone, Belinda1
  • Chouillard, Elie1
  • Sartelli, Massimo2
  • Biffl, Walter L.3
  • Di Saverio, Salomone4
  • Moore, Ernest E.5
  • Kluger, Yoram6
  • Abu-Zidan, Fikri M.7
  • Ansaloni, Luca8
  • Coccolini, Federico9
  • Leppänemi, Ari10
  • Peitzmann, Andrew B.11
  • Pagani, Leonardo12
  • Fraga, Gustavo P.13
  • Paolillo, Ciro14
  • Picetti, Edoardo15
  • Valentino, Massimo16
  • Pikoulis, Emmanouil17
  • Baiocchi, Gian Luca18
  • Catena, Fausto15
  • 1 Centre Hospitalier de Poissy/Saint Germain en Laye, Poissy, France , Poissy (France)
  • 2 Macerata’s Hospital, Macerata, Italy , Macerata (Italy)
  • 3 Scripps Memorial Hospital, La Jolla, CA, USA , La Jolla (United States)
  • 4 University Hospital of Varese, University of Insubria, Varese, Italy , Varese (Italy)
  • 5 Denver Health, Denver, CO, USA , Denver (United States)
  • 6 Rambam Health Campus, Haifa, Israel , Haifa (Israel)
  • 7 UAE University, Al-Ain, United Arab Emirates , Al-Ain (United Arab Emirates)
  • 8 Bufalini Hospital, Cesena, Italy , Cesena (Italy)
  • 9 University of Pisa, Pisa, Italy , Pisa (Italy)
  • 10 University Hospital Meilahti, Helsinki, Finland , Helsinki (Finland)
  • 11 University of Pittsburgh School of Medicine, F-1281, UPMC-Presbyterian, Pittsburgh, PA, 15213, USA , Pittsburgh (United States)
  • 12 Bolzano Central Hospital, Bolzano, Italy , Bolzano (Italy)
  • 13 Departamento de Cirurgia, Faculdade de Ciências Médicas (FCM) –Unicamp, Campinas, SP, Brazil , Campinas (Brazil)
  • 14 ASST degli Spedali Civili di Brescia, Brescia, 25123, Italy , Brescia (Italy)
  • 15 Parma University Hospital, Parma, Italy , Parma (Italy)
  • 16 Tolmezzo Hospital, Tolmezzo, Italy , Tolmezzo (Italy)
  • 17 Attikon General Hospital, National & Kapodistrian University of Athens (NKUA), Athens, Greece , Athens (Greece)
  • 18 University of Brescia, Brescia, Italy , Brescia (Italy)
Published Article
World Journal of Emergency Surgery
Springer (Biomed Central Ltd.)
Publication Date
Mar 22, 2021
DOI: 10.1186/s13017-021-00349-0
Springer Nature


BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion.ConclusionsThe aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment.We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient.The management of COVID-19 surgical patients is multidisciplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

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