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Review
. 2020 Jun;42(6):1159-1167.
doi: 10.1002/hed.26184. Epub 2020 May 6.

Framework for prioritizing head and neck surgery during the COVID-19 pandemic

Michael C Topf  1 , Jared A Shenson  1 , F Christopher Holsinger  1 , Samuel H Wald  2   3 , Lisa J Cianfichi  3 , Eben L Rosenthal  1 , John B Sunwoo  1
Affiliations
Review

Framework for prioritizing head and neck surgery during the COVID-19 pandemic

Michael C Topf et al. Head Neck. 2020 Jun.

Abstract

The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgent-consider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.

Keywords: COVID-19; SARS-CoV-2; clinical practice guidelines; head and neck cancer; surgical oncology.

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Conflict of interest statement

The authors have no funding, financial relationships, or conflicts of interest to disclose. The content contained within the manuscript has not been presented or published in any other venue.

Figures

FIGURE 1
FIGURE 1
Surgical case prioritization process during COVID‐19 pandemic [Color figure can be viewed at http://wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Preoperative clinical screening pathway for COVID‐19 [Color figure can be viewed at http://wileyonlinelibrary.com]
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization . Rolling Updates on Coronavirus Disease (COVID‐19) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a.... Accessed March 29, 2020.
    1. CDC's Recommendations for 30 day Mitigation Strategies for Santa Clara County, California, based on Current Situation with COVID‐19 Transmission and Affected Health Care Facilities. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/california-santa....
    1. CMS Adult Elective Surgery and Procedures Recommendations: Limit All Non‐essential Planned Surgeries and Procedures, Including Dental, Until Further Notice. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-.... Accessed March 29, 2020.
    1. COVID‐19: Elective Case Triage Guidelines for Surgical Care. https://www.facs.org/covid-19/clinical-guidance/elective-case. Accessed March 24, 2020.
    1. New Recommendations Regarding Urgent and Nonurgent Patient Care. https://www.entnet.org/content/new-recommendations-regarding-urgent-and-.... Accessed March 20, 2020.

MeSH terms