INTRODUCTION
Since December 2019, the COVID-19 outbreak has spread from Wuhan to
almost 4,000,000 individuals globally infected across 215 countries,
resulting in more than 270,000 deaths.[1] The first Italian patient
affected by SARS-Cov-2 was from Codogno, Lombardy, on February
21st, 2020. Since then, more than 218,000 COVID-19
cases have been confirmed in Italy, which is now one of the most
affected countries in the world, with more than 30,000 deaths.[2]
The majority of Italian cases occurred in Lombardy (81,225), home to a
sixth of the Italian population (10,08 million inhabitants), accounting
as of May 9th, of 37.2% of cases and 52.3% of deaths
in the country.[2] The Regional Government and local health
authorities adopted strategies to contain the infection whilst trying to
protect patients and healthcare workers as much as possible. Healthcare
resources were redirected to support the management of the pandemic, to
the detriment of regular elective clinical and surgical
activities.[3] Therefore, since Monday February
24th, 2020, all elective surgeries have been suspended
in our Hospital, too. Only emergency cases and those that could not be
postponed were eligible for hospital admission, in order to cope with
the increased needs for beds and intensive care unit (ICU) availability
for patients affected by COVID-19. Moreover, many Otolaryngology
departments throughout Lombardy ceased their activity, becoming areas
exclusively intended for COVID-19 patients care, thus increasing the
burden of patients affected by various head and neck diseases referring
to our Division.[4] Besides, considering that our tertiary care
center is a national referral center for sinus and skull base surgery,
the hospital general manager decided to allocate resources for providing
care to as many urgent and non-deferrable cases affected by sinus and
skull base diseases as possible. The critical issue was providing
logistics that were compatible with the ongoing epidemiological
emergency, which still represents today’s challenge. Therefore, a task
force of experts was created to produce an institutional protocol for
hospital admission, pre-operative work-up, intra-operative precautions
and post-operative care to be followed.
The aim of the present paper is to report our preliminary experience
with the management of urgent and non-deferrable endoscopic surgeries
for sinus and skull base diseases, during the COVID-19 period,
describing the evolving recommendations which have been implemented day
by day, as new evidences emerged, until reaching the actual protocol of
precautions. Clinical and surgical data, as well as the outcomes of
patients and information about healthcare workers’ exposures, are
provided. A comparison between the last two-month period and the same
period of the previous year was carried out in order to investigate the
impact of COVID-19 outbreak.