Reduce Your Risk of COVID-19 During Spine Surgery

Read the latest guidelines from medical societies, and learn how one institution has put safety protocols into practice.

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At the start of 2020, healthcare workers felt desperate for accurate information on how to protect themselves and their patients from the novel coronavirus. What a difference a year makes.

Covid risk spine surgeryHere's how HSS has put COVID-19 safety protocols into practice.

Now there’s a trove of guidelines and consensus statements. Particular attention has been paid to safety protocols for spine surgery, with its unique risks of virus transmission from emergent procedures. (Nobody wants to extubate a patient who may have COVID-19, but that’s par for the course in this pandemic era.)

Even so, not all spine specialists and surgeons are crystal clear on optimal ways to stay safe. Would you be able to answer these questions, or at least the ones relevant to your job?

  • How should staff respond to potential COVID-19 exposure during surgery?
  • When is it appropriate to schedule telemedicine visits?
  • How can we reduce aerosol generation in the operating room?
  • Who determines what procedures are elective and thus should be delayed?

You’re probably up to your elbows in safety protocols, and that’s good. After all, we‘re not out of the woods even with COVID-19 vaccinations. The Centers for Disease Control and Prevention does not yet know to what extent coronavirus vaccines confer protection against the three new, more-contagious variants in the U.S. – the ones discovered in late 2020 and early 2021in the United Kingdom, South Africa, and Brazil.

Here are some strategies to reduce the risk of COVID-19 during spine surgery. How does your facility stack up?

Strategies from the Hospital for Special Surgery

If there’s one institution to model during the pandemic, it may well be the Hospital for Special Surgery (HSS), the top-ranked orthopedic hospital in the country. In response to pandemic limitations, HSS quickly:

  • Defined an algorithm to triage and manage spine surgery patients
  • Addressed ethical considerations regarding healthcare rationing
  • Implemented safe approaches to preoperative surgical planning

These and other features of the HSS pandemic response were published last July in HSS Journal under the title “Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty Orthopedic Hospital in New York City.”

Many spine surgery protocols implemented by HSS at the start of the pandemic remain in place today. Todd J. Albert, MD, a spine surgeon and surgeon-in-chief emeritus at HSS, recently shared some insight about a few of them.

On rationing resources: “At the beginning of the pandemic, we quickly realized that preservation of scarce resources and supplies would be necessary. This mindset continues, despite liberalization in who may obtain surgery,” says Dr. Albert, who is also a SpineUniverse board member.

On presurgical COVID-19 screening: “Protecting patients and staff was and is of paramount importance. As such, we are continuing to intensively screen and PCR test all patients before admittance to the operating theater,” Dr. Albert says.

On coronavirus transmission risk in surgery: “[We established recommendations] for intubation techniques and time between intubation/extubation. Traffic patterns in the OR are also regulated,” Dr. Albert says.

On the potential risk of COVID-19 from visitors: “Mask wearing is universally required at all times. Visitation is extremely limited: one person per patient and during only a few hours during the day. Those visitors are screened at each entry,” Dr. Albert says.

Surgical Safety Advice from Medical Associations

A general perspective on COVID-safe surgical strategies can be found on the websites of medical associations such as the American Society of Anesthesiologists (ASA) and the American College of Surgeons (ACS).

The ASA offers many relevant Q&As, such as: How long should a patient wait to have elective surgery after they have had a confirmed COVID-19 infection? The answer, condensed here from a detailed version:

  • 4 weeks for an asymptomatic patient
  • 6 weeks for a symptomatic patient who wasn’t hospitalized
  • 8-10 weeks for a symptomatic patient who has major comorbidities or was hospitalized
  • 12 weeks for symptomatic patient who was admitted to an intensive care unit

Meanwhile, the ACS offers recommendations to help you determine when and whether to perform nonessential surgeries during the pandemic. Factors to consider should include local case incidence, availability of PPE as well as hospital beds, and an assessment (by a qualified physician) of surgical urgency. Ongoing and updated guidance can be found at the American College of Surgeons online home. 

 

Updated on: 02/08/21
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Docs Must Take the Lead in Prioritizing Surgery
Todd J. Albert, MD
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