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. 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. Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. 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. 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. The management of COVID-19 surgical patients is multidisciplinary. 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.

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COVID-19 大流行期间紧急情况下手术患者的管理：WSES 立场文件

自COVID-19大流行发生以来，各国在应对如此规模和严重程度的大规模伤亡事件方面表现出毫无准备，导致大量医护人员死亡。世界急诊外科学会撰写本立场文件的目的是为在 COVID-19 大流行期间管理急诊外科患者提供基于证据的建议，以确保患者和医护人员的安全。根据系统评价和荟萃分析方案的首选报告项目 (PRISMA-P)，通过 MEDLINE (PubMed)、Embase 和 SCOPUS 数据库进行了系统评价。证据、陈述和建议的综合是根据 GRADE 方法制定的。鉴于证据有限，当前文件代表了将精选的高质量文章和专家意见结合起来的努力。本立场文件的目的是提供详尽的指南，以便在安全和受保护的环境中为手术患者和 COVID-19 下的医护人员进行紧急手术，并为需要紧急手术治疗的 COVID-19 患者提供最佳管理。我们建议在急诊科对所有等待入院和紧急手术的急性外科患者进行 COVID-19 感染筛查。筛查检查提供 RT-PCR 鼻咽拭子测试和基线（非对比）胸部 CT 或胸部 X 光检查或肺部超声检查，具体取决于技能和可用性。如果未完成 COVID-19 筛查，我们建议将患者隔离直至无法获得 RT-PCR 拭子检测结果，并将其作为明显的 COVID 患者进行管理。COVID-19 手术患者的管理是多学科的。如果必须立即进行手术，无论是腹腔镜手术还是开放手术，我们建议尽一切努力保护手术室工作人员的患者安全。