TPFS COVID Update May 2020

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TPFS COVID Update May 2020

  • 20th February 2019

The Pelvic Floor Society Guidance on the Management of Functional Colorectal Disorders and Preparing Patients for Elective Surgery in the Early Recovery Phase of the COVID-19 Pandemic

Introduction

Within the field of pelvic floor medicine, elective surgery forms a smaller, but nevertheless significant, workload compared with other surgical specialties. Whilst guidance from many surgical colleges and associations has concentrated on re-entry programs for surgical conditions and procedures during and following-on from the COVID- 19 pandemic, this advice will only pertain to a smaller number of patients under the care of a pelvic floor surgeon or allied health care professional (AHP). Admittedly there will be patients on waiting lists for prolapse and continence procedures, and guidance is required for these with regard to both patients and healthcare professionals (HCPs). Whilst clinicians continue to consult with new patients, advice is required for these too. There are also larger numbers of patients in treatment care pathways delivered by AHPs, awaiting multidisciplinary meeting (MDM) decisions, or waiting for investigations, and further guidance is required here.

To many, treatment of functional and pelvic prolapse disorders is perceived as quality of life medicine/surgery. The severity of some of these conditions, however, when combined with an often elderly, vulnerable population, perhaps mentally scarred by months of isolation, in some case necessitates timely and needful action.

Any re-entry program for any treatment or investigation must be safe and effective with a high benefit/low risk profile. Healthcare professionals normally discuss a patient- centred approach, particularly in the field of pelvic floor medicine. Due to COVID-19, thismust change to a ‘bi-centred’ approach, taking into account of the safety and outcomes of both patients and staff.

Guidance for the Management of Patients on Waiting Lists for Surgery

Pre-existing Guidance
Both ACPGBI and the United Kingdom Royal Colleges of Surgeons have published

guidance on prioritising emergency and elective surgical patients during the pandemic. ACPGBI guidance focused on the patient, combining surgical condition priority, vulnerability and the environmental risk of contracting COVID-19 (click here). A joint statement from the Royal Colleges gave guidance on the recovery of surgical services during and after the pandemic (click here). This statement focuses on the reconfiguration of services, the workforce, facilities, and supporting the workforce.

As the United Kingdom enters the early recovery phase of the COVID-19 pandemic, guidance on safety and risk to both patients and staff (bi-centred approach) with planned surgery would be helpful. The American College of Surgeons together with other professional organisations published a road map for resuming elective surgery post-COVID- 19 (click here). Within this useful document there is reference to an article published by theCollege’s journal which introduces a new scoring system which attempts to quantify risk foran individual su