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Framework for prioritizing head and neck surgery during the COVID‐19 pandemic
Authors:Michael C. Topf  Jared A. Shenson  F. Christopher Holsinger  Samuel H. Wald  Lisa J. Cianfichi  Eben L. Rosenthal  John B. Sunwoo
Abstract:The COVID‐19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non‐urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent—proceed with surgery, less urgent—consider postpone > 30 days, less urgent—consider postpone 30 to 90 days, and case‐by‐case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low‐risk and high‐risk surgery for transmission and role of preoperative COVID‐19 testing.
Keywords:clinical practice guidelines  COVID‐19  head and neck cancer  SARS‐CoV‐2  surgical oncology
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