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.