Latest News

10 August 2020

 

 

Update: 10 August 2020

 

The ASOHNS’ COVID-19 Working Group has reviewed and supports the new guidelines issued by the Infection Control Expert Group on 6 August titled “COVID-19 Guidance on the use of personal protective equipment by health care workers in areas with significant community transmission”.

These guidelines can be viewed online – click here

 

The guidelines support increased protection given the current situation in Victoria and can be implemented in any location where there is significant community transmission.

 

We encourage health care institutions and workplaces to provide a reliable supply of appropriate PPE to clinicians to perform their duties safely.

 

Further, ASOHNS recommends that where P2 / N95s are not available for aerosol-generating procedures, and deferral of care does not pose an unacceptable risk of harm to a patient, we support our members deferring procedures until the risk of inadvertent exposure is considered at an acceptable level for that clinician, or until appropriate PPE is provided.

 

RACS communicated to Victorian fellows on Friday 7 August. A copy is included below as it will be relevant for us all to consider for our patients.

 

We are hopeful that the steps taken in Victoria to reduce community transmission will protect our colleagues.

For members and trainees in Victoria, please know that you are in our thoughts and if we can support you in any way, please let me know.

 

I am attending a meeting on Thursday 13 August with RACS and Dr Nick Coatsworth, Deputy Chief Medical Officer, and will keep you informed on any changes to guidelines following that meeting,

 

Kind regards,

 

Suren Krishnan OAM FRACS

ASOHNS President

 

__________________________________________________________________________________________

Guidance on delay to elective surgery post recovery from SARS-CoV-2 infection (issued on 5 August 2020)

 

Dear colleagues,

 

We are pleased to share guidance for elective procedures post COVID. This was agreed to at the Victorian meeting of College state chairs and presidents last week. It provides good guidance for all our members in a rapidly developing field.

 

Background
The severity and duration of SARS-CoV-2 infection is variable between individuals. There is increasing evidence of an incidence of post infection impairment despite significant gaps in our understanding as to how long the respiratory (1), cardiovascular (2) and other systems may be affected. It appears that infection (communicability) recovery is much quicker than physiologic recovery. 

 

Available evidence suggests patients who had SARS-CoV-2 infection diagnosed within seven days before or up to 30 days after surgery are at significant risk of post-operative complications including increased morbidity and mortality.(3) 

 

There are insufficient additional data to provide universal recommendations on the optimum timing of necessary, planned surgery following recovery from active infection with SARS-CoV-2. Therefore, a cautious approach is recommended. Decisions regarding surgical timing will require careful consideration of the possible sequelae of the infection, the urgency of the required surgery and the expected physiological impact on the patient.

 

Guidelines
A minimum of eight weeks of being symptom free prior to undergoing all but minor elective surgical procedures is recommended.

Patients should have a formal clinical review prior to surgery that particularly addresses the state of the cardiac and respiratory systems. This is recommended for all patients post known SARS-CoV-2 infection and is especially important in those who have any persisting 

 

Not ready for care?
If, on careful consideration of the nature and severity of any persisting problems, delay is considered the safer course of action for an individual patient, we recommend treatment is delayed until the balance of risks and benefits are more in the patient’s favour, even for a Category 1 (within 30 days) case.

 

This guidance will be updated when more evidence of the longer term’s effects of infection with SARS-CoV-2 is available.

 

 

1. Zhao Y, Shang Y, Song W, Li Q, Xie H, Xu Q, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020 Jul;100463.

2. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol [Internet]. 2020 Jul 27 [cited 2020 Aug 3]; Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916

3. Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet. 2020 Jul;396(10243):27–38.
 

Kind regards

 

Dr Tony Sparnon                                Mr Matthew Hadfield
President                                            Chair, Victorian State Committee

 

 

 

Disclaimer

The Australian Society of Otolaryngology Head and Neck Surgery has developed this information as guidance for its members. This is based on information available at the time of writing and the Society recognises that the situation is evolving rapidly, so recommendations may change. The guidance included in this document does not replace regular standards of care, nor do they replace the application of clinical judgement to each individual presentation, nor variations due to jurisdiction or facility type.


The Australian Society of Otolaryngology Head and Neck Surgery Limited is not liable for the accuracy or completeness of the information in this document. The information in this document cannot replace professional advice.