Consensus-based perioperative protocols during the COVID-19 pandemic

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  • 1 Departments of Neurological Surgery,
  • 2 Surgery,
  • 3 Anesthesia and Perioperative Medicine,
  • 5 Orthopedic Surgery,
  • 8 Otolaryngology Head and Neck Surgery,
  • 9 Radiology and Biomedical Imaging,
  • 11 Neurology,
  • 14 Medicine, and
  • 15 Urology;
  • 6 Divisions of Vascular and Endovascular Surgery,
  • 7 Infectious Diseases,
  • 10 Interventional Neuroradiology,
  • 12 Vascular and Interventional Radiology, and
  • 13 Cardiology;
  • 4 Chancellor’s Cabinet; and
  • 16 Perioperative Care, University of California, San Francisco, California
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OBJECTIVE

During the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints.

METHODS

A multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95% consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion.

RESULTS

Overall, 15 of 18 statements achieved consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus. Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery.

CONCLUSIONS

Urgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic.

ABBREVIATIONS ACS = American College of Surgeons; ICU = intensive care unit; MDPC = multidisciplinary perioperative committee; PAPR = powered air-purifying respirator; PPE = personal protective equipment; PUI = inpatients under investigation; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; UCPS = UCSF COVID-19 PPE Score; UCSF = University of California, San Francisco.

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Contributor Notes

Correspondence Praveen V. Mummaneni: University of California, San Francisco, CA. praveen.mummaneni@ucsf.edu.

INCLUDE WHEN CITING Published online October 2, 2020; DOI: 10.3171/2020.6.SPINE20777.

Disclosures Dr. P. Mummaneni reports being a consultant for Globus, DePuy Synthes, and Stryker; having direct stock ownership in Spinicity/ISD; receiving support of non–study-related clinical or research effort from ISSG, AO Spine, and the NREF; and receiving royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers. Dr. Chan reports support of non–study-related clinical or research effort from Orthofix Medical, Inc. Dr. Sosa reports being on the data monitoring committee of the Medullary Thyroid Cancer Consortium Registry supported by GlaxoSmithKline, Novo Nordisk, Eli Lilly, and AstraZeneca; and institutional research funding support of non–study-related clinical or research effort from Exelixis and Eli Lilly. Dr. Berven reports being a consultant for Medtronic, Stryker, Medicrea, Innovasis, and Integrity; receiving royalties from Medtronic and Stryker; having ownership in Green Sun Medical and Providence Medical; and being on the JNS Editorial Board. Dr. Goldberg reports being an advisor to Keyssa, Inc. Dr. Vail reports receiving royalties from DePuy and having ownership in Hyalex.

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