. 2020 Apr 27;31(6):1063–1089. doi: 10.1007/s00192-020-04314-4

Table 3.

Perioperative considerations: non-elective cases

Operative state	Recommendation
Preoperative	• Screen all patients for symptoms upon arrival to the healthcare setting; triage for testing based on symptoms • Consider universal testing once availability of COVID-19 kits increases • Consider a chest x-ray as a screening tool since it may be obtained faster than confirmatory testing
Intraoperative	• For COVID-19-positive cases: - Operating room staff should have full personal protective equipment, and only essential personnel should be present - Limit movement of personnel in and out of the OR especially during airway management given the increased risk of aerosolization of viral particles - Consider laparotomy vs. laparoscopy by balancing the risks of surgical morbidity to the patient with risk of viral transmission to the provider - Limit use of electrocautery unless absolutely necessary for patient safety. If used, electrocautery devices should be used at the lowest effective setting and in conjunction with deliberate smoke suctioning with filters when energy is used - Insufflation during laparoscopic cases should be kept to a minimum and completely evacuated through a filtration system prior to trocar venting or removal
Postoperative	• Same-day discharge should be encouraged to avoid prolonged hospitalization and reduce hospital burden • For COVID-19-positive cases: - Consider prophylaxis or treatment doses of anticoagulation as COVID-19 infections may produce a hypercoagulable state

Operative state

Recommendation

Preoperative

• Screen all patients for symptoms upon arrival to the healthcare setting; triage for testing based on symptoms

• Consider universal testing once availability of COVID-19 kits increases

• Consider a chest x-ray as a screening tool since it may be obtained faster than confirmatory testing

Intraoperative

• For COVID-19-positive cases:

- Operating room staff should have full personal protective equipment, and only essential personnel should be present

- Limit movement of personnel in and out of the OR especially during airway management given the increased risk of aerosolization of viral particles

- Consider laparotomy vs. laparoscopy by balancing the risks of surgical morbidity to the patient with risk of viral transmission to the provider

- Limit use of electrocautery unless absolutely necessary for patient safety. If used, electrocautery devices should be used at the lowest effective setting and in conjunction with deliberate smoke suctioning with filters when energy is used

- Insufflation during laparoscopic cases should be kept to a minimum and completely evacuated through a filtration system prior to trocar venting or removal

Postoperative

• Same-day discharge should be encouraged to avoid prolonged hospitalization and reduce hospital burden

• For COVID-19-positive cases:

- Consider prophylaxis or treatment doses of anticoagulation as COVID-19 infections may produce a hypercoagulable state