Patients management during COVID-19 two-months period
Indications . The criteria for hospital admission were
established as follows[5]:
- urgent surgical operations such as severe trauma, bleeding,
infections/abscesses;
- sinus lesions suspected for malignancy, needing biopsy in general
anesthesia;
- non-deferrable surgical interventions, such as malignant tumors with
critical local extension to brain, orbit and/or with borderline
resectability, where a delay in treatment might be fatal for the
prognosis quoad vitam et valetudinem;
- pituitary tumors or skull base lesions with rapidly worsening vision
- meningiomas and other skull base tumors presenting with hydrocephalus
or brainstem compression symptoms;
- rapidly evolving clinical conditions determining acute organ
impairment (e.g. compressive optic neuropathy, intraorbital abscess)
Swab specimens . Indications for nasopharyngeal and/or
oropharyngeal swab collection evolved during the COVID-19 two-month
period. In the early period, swab testing was performed before
hospitalization in case of body temperature more than 37.5°C and/or in
presence of at least one of the following factors: fever, cough,
dyspnoea, gastrointestinal signs/symptoms, myalgias, fatigue, headache,
pharyngodynia, rhinorrhea, active pneumonia and close contact with a
SARS-Cov-2 positive patient. Otherwise, patients were admitted without
getting tested. Given the worsening of the pandemic and the growing body
of data available, indications changed on March 23rd,
2020, when all inpatients were systematically submitted to swab specimen
collection, so that only emergencies have been performed notwithstanding
their COVID-19 status. More specifically, the execution of two swabs,
with an interval between the two tests of at least 2 days and the latest
performed within 48 hours prior to surgery, has become mandatory, in
order to minimize the possibility of false negatives.
Individual protection . Indications for the use of personal
protective equipment (PPE) have also evolved during this period. At the
beginning, no specific protection was recommended during surgery and all
healthcare workers in the Operating Room (OR) continued to wear standard
surgical masks and gowns, leaving viral-filtering-PPE available to be
used only in case of confirmed COVID-19 patients. However, after March
23rd, 2020, indications for PPE use changed and, since
then, surgical procedures in COVID-19 negative patients required the use
of the highest individual protection standards (at least FFP2 masks), in
consideration of the significant number of false negatives resulting
from the swab tests currently used. For positive patients, procedures
were postponed until after swab test negativization, when feasible. If
the procedure was strictly necessary for the patient’s survival, surgery
was performed in a dedicated negative-pressure operating room with a
pre-established allocated run, without interfering with the
COVID-19-free areas. All medical and nursing staff in the operating room
were recommended to wear FFP3 and/or powered air-purifying respirators
(PAPR), goggles, full-face visor, double gloves, water-resistant gowns
and protective caps, not only for the entire duration of surgery but
also for the whole of the patient’s stay in the operating room.[6]
If testing for COVID-19 was not available (emergency procedures such as
trauma, major bleeding, abscesses), patients were considered COVID-19
positive unless otherwise demonstrated.
Follow-up. Postoperative management and follow-up for
patients undergoing sinus and skull base procedures followed
standardized protocols already established at our Department[7–9].
Nasal packing are removed on the second postoperative day and following
endonasal medications are performed as needed, until hospital discharge.
Then, patients are prescribed daily nasal rinses and postoperative
control in the outpatient clinic, where further medications are
performed. Even though the SARS-Cov-2 outbreak influenced long term
follow-up of outpatients in our Clinic, post-operative medications were
guaranteed in all cases, even during the COVID-19 era, thanks to an
accurate reorganization of several aspects of the outpatient
service.[10] In order to investigate the health of the patients
belonging to the PANDEMIC-Group after their last postoperative
medication, a telephone interview was carried out retrospectively,
examining the following factors: fever, cough, dyspnoea, anosmia,
dysgeusia, gastrointestinal signs/symptoms, myalgias, fatigue, headache,
pharyngodynia, rhinorrhea, active pneumonia, need for hospitalization
for any reason, potential swab or serological tests performed and if
they had been in contact with COVID-19 positive individuals.