The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.</jats:p> </jats:sec><jats:sec> <jats:title>Method</jats:title> <jats:p>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment.</jats:p> <jats:p>We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient.</jats:p> <jats:p>The management of COVID-19 surgical patients is multidisciplinary.</jats:p> <jats:p>If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.</jats:p> </jats:sec>