The American College of Surgeons (ACS) has announced the release of new clinical guidance for surgeons to curtail recommendations for elective surgical procedures, with the aim of preserving necessary resources for the care of critically ill patients during the COVID-19 pandemic.
To assist in surgical decision-making on the curtailing of cases, ACS has released “COVID-19: Elective Case Triage Guidelines for Surgical Care”, a new surgical triage document that was developed following expert review in several specialties and provides trusted information from the most current, best evidence available in a number of surgical fields, including vascular surgery and the treatment of wounds.
A range of procedures for the treatment of wounds have been graded from 1 to 3, depending on whether they should be postponed or not. No procedures related to wounds, gangrene or amputation have been deemed grade 1, which are those that should be postponed,
Grade 2 procedures are divided into those which specialists should consider postponing (2a), and those which should be postponed if possible (2b). In the case of wounds, 2b procedures include: the treatment of wounds requiring skin grafts; amputation of toes for infection or necrosis; and deep debridement of surgical wound infection or necrosis
Grade 3 procedures should not be postponed, and the ACS has decided that amputation of non-salvageable limbs due to lower extremity disease, and amputations for infection or necrosis (transmetatarsal, below knee, above knee), are the only exceptions listed under this category with regards to wounds.
According to a statement, these triage recommendations should be used in conjunction with a joint statement ACS has developed with the American Society of Anaesthesiologists (ASA) and the Association of Perioperative Registered Nurses (AORN), recommending medical centres to develop a Surgical Review Committee to act as an administrative body, providing defined, transparent, and responsive oversight for triaging surgical cases during the COVID-19 pandemic.
Moreover, the ACS, ASA, and AORN recommend decisions of the Surgical Review Committee regarding surgical cases be made on a daily basis, no later than the day before an operation, and should include a multidisciplinary leadership team representing surgery, anaesthesiology, and nursing.
David B Hoyt, ASC Executive Director, comments: “These triage guidelines and joint recommendations are being issued as we appear to be entering a new phase of the COVID-19 pandemic with more hospitals facing a potential push beyond their resources to care for critically ill patients.
“ACS will continue to monitor the landscape for surgical care but we feel this guidance document provides a sound foundation for surgeons to begin enacting these triage recommendations today to help them make the best decisions possible for their patients during COVID-19.”
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