Designing a Guideline for Elective and Emergency Spinal Cord Surgeries During the COVID-19 Pandemic

There is a need to prepare clinical guidelines for conducting elective or emergency spinal cord surgeries in people who may be carriers of the COVID-19. Therefore, the study aimed to design a guideline for conducting elective spinal cord surgeries during the COVID-19 pandemic. The clinical guidelines and systematic reviews providing recommendations for elective and emergency spinal cord surgeries were collected by an initial search. A group of nine experts were designed a domestic preliminary guideline using six available guidelines presented in four studies. Scoring was conducted based on the AGREE (Appraisal of Guidelines Research and Evaluation) tool. The guideline was prepared in eight subscales, including outpatient visit and counseling, protective measures for health personnel, surgical considerations during the coronavirus pandemic, intraoperative considerations, managing aerosol producing activities, elective and emergency spinal cord surgery, and patient intubation and cardiopulmonary resuscitation. Each of these subscales included several specific recommendations. It recommended to reduce the capacity of inpatient wards to half during the coronavirus pandemic, give priority only to emergency surgeries, presence of skilled residents (senior year residents), use personal protective equipment, use the least number of people in the operating room, and reduce the length of surgery without compromising its quality.