Mummaneni Praveen V, Burke John F, Chan Andrew K, Sosa Julie Ann, Lobo Errol P, Mummaneni Valli P, Antrum Sheila, Berven Sigurd H, Conte Michael S, Doernberg Sarah B, Goldberg Andrew N, Hess Christopher P, Hetts Steven W, Josephson S Andrew, Kohi Maureen P, Ma C Benjamin, Mahadevan Vaikom S, Molinaro Annette M, Murr Andrew H, Narayana Sirisha, Roberts John P, Stoller Marshall L, Theodosopoulos Philip V, Vail Thomas P, Wienholz Sandra, Gropper Michael A, Green Adrienne, Berger Mitchel S
Departments of1Neurological Surgery.
2Surgery.
J Neurosurg Spine. 2020 Oct 2;34(1):13-21. doi: 10.3171/2020.6.SPINE20777. Print 2021 Jan 1.
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.
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.
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.
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.
在新冠疫情期间，四级医疗设施持续为需要紧急侵入性手术的患者提供护理。尽管存在能力和资源限制，仍需要围手术期方案来简化对这些患者的护理。
在加利福尼亚大学旧金山分校组建了一个多学科小组，由来自10个学术部门的26位负责人组成，包括7位系主任、首席医疗官、首席运营官、感染控制官员、护理负责人以及住院医师代表。还咨询了一位流行病学家、一位伦理学家和一位统计学家。采用基于18条同意/不同意陈述的改良两轮盲法德尔菲法来达成共识。使用单侧精确二项式检验对每条陈述的显著分歧进行测试，以95%的共识预期结果为对照，显著性阈值为p < 0.05。通过非盲的小组层面讨论制定最终的分诊方案。
总体而言，在德尔菲法的第一轮中，18条陈述中有15条达成了共识；3条存在显著分歧（p < 0.01）的陈述经过修改后反复提交给专家小组以达成共识。通过非盲的多学科小组讨论制定了基于共识的方案。最终的算法1）对疫情级别进行量化，2）根据急症程度对患者进行分诊，3）提供紧急/急诊侵入性手术的清单，4）创建了一个用于分配个人防护装备的新型评分系统。特别是，作者修改了美国外科医师学会的三级分诊系统，以纳入神经外科和脊柱外科中常见的更紧急病例。
在新冠疫情期间需要进行紧急和急诊侵入性手术。本研究中基于共识的方案可能有助于医疗保健提供者在疫情期间优化围手术期护理。
