Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

array:24 ["pii" => "S2173507722000291" "issn" => "21735077" "doi" => "10.1016/j.cireng.2022.02.014" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2538" "copyright" => "AEC" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2022;100:115-24" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X21001603" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2021.04.012" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2538" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2022;100:115-24" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "Artículo especial" "titulo" => "Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "124" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 750 "Ancho" => 1333 "Tamanyo" => 181358 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dieter Morales-García, Fernando Docobo-Durantez, J.M. Capitán Vallvey, Juan Manuel Suarez-Grau, María Eugenia Campo-Cimarras, Salustiano González-Vinagre, Luis Antonio Hidalgo-Grau, J.M. Puigcercos-Fusté, Cristóbal Zaragoza-Fernández, Zoraida Valera-Sánchez, Vicente Vega-Ruiz" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Dieter" "apellidos" => "Morales-García" ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Docobo-Durantez" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Capitán Vallvey" ] 3 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Suarez-Grau" ] 4 => array:2 [ "nombre" => "María Eugenia" "apellidos" => "Campo-Cimarras" ] 5 => array:2 [ "nombre" => "Salustiano" "apellidos" => "González-Vinagre" ] 6 => array:2 [ "nombre" => "Luis Antonio" "apellidos" => "Hidalgo-Grau" ] 7 => array:2 [ "nombre" => "J.M." "apellidos" => "Puigcercos-Fusté" ] 8 => array:2 [ "nombre" => "Cristóbal" "apellidos" => "Zaragoza-Fernández" ] 9 => array:2 [ "nombre" => "Zoraida" "apellidos" => "Valera-Sánchez" ] 10 => array:2 [ "nombre" => "Vicente" "apellidos" => "Vega-Ruiz" ] 11 => array:1 [ "colaborador" => "Grupo de Trabajo CIRUGIA-AEC-COVID-19" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<elsevierMultimedia ident="fig0015"></elsevierMultimedia>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507722000291" "doi" => "10.1016/j.cireng.2022.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000291?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21001603?idApp=UINPBA00004N" "url" => "/0009739X/0000010000000003/v1_202203020514/S0009739X21001603/v1_202203020514/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507722000266" "issn" => "21735077" "doi" => "10.1016/j.cireng.2022.02.011" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2480" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2022;100:125-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "132" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Duodenopancreatectomía por adenocarcinoma ductal de páncreas en ancianos. ¿Podemos asumirla con seguridad?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 886 "Ancho" => 1575 "Tamanyo" => 191163 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Pineño-Flores, David Ambrona-Zafra, Jose Carlos Rodríguez-Pino, Carla Soldevila-Verdeguer, Elias Palma-Zamora, Francesc Xavier Molina-Romero, Jose Miguel Morón-Canis, Francesc Xavier González-Argente, Rafael Morales-Soriano" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Pineño-Flores" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Ambrona-Zafra" ] 2 => array:2 [ "nombre" => "Jose Carlos" "apellidos" => "Rodríguez-Pino" ] 3 => array:2 [ "nombre" => "Carla" "apellidos" => "Soldevila-Verdeguer" ] 4 => array:2 [ "nombre" => "Elias" "apellidos" => "Palma-Zamora" ] 5 => array:2 [ "nombre" => "Francesc Xavier" "apellidos" => "Molina-Romero" ] 6 => array:2 [ "nombre" => "Jose Miguel" "apellidos" => "Morón-Canis" ] 7 => array:2 [ "nombre" => "Francesc Xavier" "apellidos" => "González-Argente" ] 8 => array:2 [ "nombre" => "Rafael" "apellidos" => "Morales-Soriano" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<elsevierMultimedia ident="fig0015"></elsevierMultimedia>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X21000294" "doi" => "10.1016/j.ciresp.2021.01.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21000294?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000266?idApp=UINPBA00004N" "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000266/v1_202203130532/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507722000230" "issn" => "21735077" "doi" => "10.1016/j.cireng.2021.06.021" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "2573" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Cir Esp. 2022;100:113-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Textbook outcome: A new quality tool" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "114" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Textbook outcome (resultado de libro): una nueva herramienta de gestión" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jose M. Ramia, Victoriano Soria-Aledo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Jose M." "apellidos" => "Ramia" ] 1 => array:2 [ "nombre" => "Victoriano" "apellidos" => "Soria-Aledo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X21002153" "doi" => "10.1016/j.ciresp.2021.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21002153?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000230?idApp=UINPBA00004N" "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000230/v1_202203130532/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "124" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Dieter Morales-García, Fernando Docobo-Durantez, J.M. Capitán Vallvey, Juan Manuel Suarez-Grau, María Eugenia Campo-Cimarras, Salustiano González-Vinagre, Luis Antonio Hidalgo-Grau, J.M. Puigcercos-Fusté, Cristóbal Zaragoza-Fernández, Zoraida Valera-Sánchez, Vicente Vega-Ruiz" "autores" => array:12 [ 0 => array:4 [ "nombre" => "Dieter" "apellidos" => "Morales-García" "email" => array:1 [ 0 => "dms11@me.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fernando" "apellidos" => "Docobo-Durantez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Capitán Vallvey" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Juan Manuel" "apellidos" => "Suarez-Grau" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "María Eugenia" "apellidos" => "Campo-Cimarras" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 5 => array:3 [ "nombre" => "Salustiano" "apellidos" => "González-Vinagre" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 6 => array:3 [ "nombre" => "Luis Antonio" "apellidos" => "Hidalgo-Grau" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 7 => array:3 [ "nombre" => "J.M." "apellidos" => "Puigcercos-Fusté" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 8 => array:3 [ "nombre" => "Cristóbal" "apellidos" => "Zaragoza-Fernández" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 9 => array:3 [ "nombre" => "Zoraida" "apellidos" => "Valera-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 10 => array:3 [ "nombre" => "Vicente" "apellidos" => "Vega-Ruiz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 11 => array:2 [ "colaborador" => "Surgery-AEC-COVID-19 workgroup" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:12 [ 0 => array:3 [ "entidad" => "Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario «Marqués de Valdecilla», Instituto de Investigación IDIVAL, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Comité Científico, Asociación Andaluza de Cirujanos, Andalucía, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitario de Jaén, Jaén, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Riotinto, Huelva, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Txagorritxu, Vitoria, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Hospital Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Hospital de Mataró, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Hospital Dos de Mayo, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Hospital Universitario Puerto Real, Cádiz, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 750 "Ancho" => 1333 "Tamanyo" => 159316 ] ] ] ] "textoCompleto" => "IntroductionIn February 2021, the world is still mired in the pandemic due to the SARS-CoV-2 virus. Spain in particular<a class="elsevierStyleCrossRef" href="#bib0005">1</a> is suffering the consequences, as it is immersed in a third wave that is forcing us to suspend surgeries of all kinds (except emergencies) in many hospitals of our country. However, despite this serious situation, we cannot and should not forget that, in addition to COVID-19, many patients have surgical problems, etc, that have an even greater effect on their lives. Elective surgical activity must prioritize the safety of patients and healthcare professionals throughout the process<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>. However, as stated by Balibrea<a class="elsevierStyleCrossRef" href="#bib0020">4</a>, surgery must continue. We cannot let patients with non-COVID pathology be neglected, patients who have been waiting for months for a surgical intervention that in many instances affects their family life, social life and occupational life in addition to their health. Moving forward, this situation should make us reflect on all the possible lines of action<a class="elsevierStyleCrossRef" href="#bib0025">5</a>, and ambulatory surgery is a process that offers alternatives.As doctors and as part of the society involved, we collaborate in the search for the most appropriate solutions in these times of urgency, in which all available resources have been made available to control the pandemic. As surgeons, we have developed our role in these special circumstances, with strategic, instrumental and personal support.This has led to a profound change in healthcare activity, from the transfer of surgical hospital beds to care for patients admitted due to COVID-19, to establishing online consultations or teleconsultations to avoid infecting other patients, as well as the cancellation of scheduled surgeries, operating exclusively on individuals with urgent or serious oncological conditions that cannot be postponed. In certain cases, this has meant that patients have come to the Emergency Department in not exactly the best condition<a class="elsevierStyleCrossRef" href="#bib0030">6</a>.The evidence existing to date, both on the infection and on the surgical approach to it, has been intensively and continuously shared and updated in a short space of time by the Spanish Association of Surgeons (AEC) and its divisions<a class="elsevierStyleCrossRefs" href="#bib0010">2,3,7–10</a>, in permanent contact with other scientific societies<a class="elsevierStyleCrossRefs" href="#bib0055">11–16</a>. This has made it possible to treat a large number of patients and has put the entire Spanish healthcare system to a great test of strength, and the response of all health professionals is being exceptional.In this situation, there is much long-term scientific evidence to demonstrate that ambulatory surgery is a safe, effective and efficient system for resolving the processes included in the portfolio of services offered<a class="elsevierStyleCrossRefs" href="#bib0085">17–19</a>.From the Ambulatory Surgery Division of the AEC, on behalf of all the surgeons who perform day surgery in our country, we believe that this is an example of quality and efficiency of care that should be established as the center of scheduled surgical activity in these difficult times. Surgical treatment circuits and the function of services should be redesigned to achieve outpatient treatment rates in line with those established in our setting. This can and should be a priority solution to the great demand for surgery that lies ahead after the COVID-19 epidemic<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a>.The role of scientific societies in coordination with healthcare authorities is crucial in dealing with this pathology. When there is good coordination and receptivity, the suggestions of scientific societies, in this case the Spanish Association of Major Ambulatory Surgery (ASECMA) and its Board of Directors, have managed to improve the resolutions published in different government bulletins based on the existing evidence, providing solutions<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> and giving day surgery the significant role it should play at this time.From the outset, the AEC, its divisions and the Surgery-AEC-COVID-19 workgroup<a class="elsevierStyleCrossRef" href="#bib0015">3</a>, together with other societies (including ASECMA)<a class="elsevierStyleCrossRef" href="#bib0075">15</a>, have drawn up recommendations to be used as a guideline for the development of local protocols<a class="elsevierStyleCrossRef" href="#bib0080">16</a>. Following these recommendations and adapting them to the day surgery setting, we propose a series of actions to be able to safely continue operating with guaranteed safety for patients, which must be reviewed as the epidemic evolves.Management of ambulatory surgery in SARS-CoV-2The ambulatory surgery unit must be clearly defined in a perfectly separated COVID-free environment, regardless of whether it forms part of the physical structure of the hospital or is an isolated unit<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>.The management recommendations are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1There must be a specific day surgery committee within the hospital’s COVID surgical committee, with representation of specialists and units involved in day surgery, who, as experts, advise on decision-making for ‘what, how and in what way’ while taking into account the epidemiological risk and the resources available. This sort of plan is very important at this time.</li><li class="elsevierStyleListItem" id="lsti0010">2Similarly, the ambulatory surgery circuit must be clearly differentiated in the hospital (regardless of the unit type available), from the hospital access to the consultations and in the surgical area itself, as well as the location of the ambulatory surgery unit.</li><li class="elsevierStyleListItem" id="lsti0015">3It is highly recommended that the consultation for surgery, nursing and anesthesia be simultaneous and on the same day that the patient is included on the surgical waiting list, in the so-called “one-step consultation”<a class="elsevierStyleCrossRef" href="#bib0075">15</a>.</li><li class="elsevierStyleListItem" id="lsti0020">4Regarding the management of people, at this time it would be advisable to have a specific team from and for ambulatory surgery, in which the professionals could be distributed in work shifts in order to be able to immediately cover any contingency without negatively affecting treatment or continuity of care.</li></ul>Selection of patients for ambulatory surgeryThe selection of patients for ambulatory surgery based on medical, social or day surgery criteria, etc, is perfectly defined for each procedure within the different guidelines<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a>, as well as in the intra-hospital protocols of each institution based on its portfolio of services.In the current situation, we should be able to identify which patients and which pathologies require surgery, and with what level of priority. To this end, the guidelines of the American College of Surgeons (ACS) and the AEC can be used as a reference<a class="elsevierStyleCrossRefs" href="#bib0060">12,16,24,25</a>, and also for oncology patients.We must take into account the pathology that is the cause of the intervention, the procedure and the patient’s status. The AEC proposes a dynamic scale that defines 5 phases in the evolution of the COVID-19 pandemic as it waxes and wanes<a class="elsevierStyleCrossRef" href="#bib0035">7</a>.The Ambulatory Surgery Division proposes establishing surgical priorities based on the following factors:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025">1In the current situation, criteria such as priority at the time of inclusion (standard, preferential and urgent) should be used to indicate the surgery of patients who have been included preferentially or urgently, which is done based on strictly objective criteria, as well as the current situation of the patient, which may have changed since their inclusion on the waiting list.</li><li class="elsevierStyleListItem" id="lsti0030">2Surgical activity will be determined by the phase of the pandemic in which we find ourselves.</li><li class="elsevierStyleListItem" id="lsti0035">3<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> proposes a prioritization of interventions based on diagnosis, such as ‘priority 1’ or ‘priority 2’ diagnoses. This is basically done according to the degree of complexity and depending on whether the surgical intervention can be performed with an anesthetic technique that does not require instrumental manipulation of the airway. Also, we must not forget that, although day surgery encompasses moderately complex procedures, more and more complex patients are now being treated, and surgeries are being performed with greater difficulty.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0040">4In the current situation, the immediate incorporation of new procedures (not previously included, or no previous experience) in the portfolio of services is not recommended, but this will depend on each center and day surgery team.</li><li class="elsevierStyleListItem" id="lsti0045">5The patient’s risk, classified according to predictive factors for 30-day mortality<a class="elsevierStyleCrossRef" href="#bib0055">11</a>, may be high: male patients, >70 years, with significant associated comorbidity (American Society of Anesthesiologists [ASA] classification III or IV) and in need of major surgery for oncological pathology; or moderate in the remaining situations<a class="elsevierStyleCrossRefs" href="#bib0065">13,16</a>. By definition, the risk of ambulatory surgery procedures is moderate or low.</li><li class="elsevierStyleListItem" id="lsti0050">6In the case of cancer patients in alert stage III, we should operate on those individuals whose treatment cannot be delayed because their survival could worsen within the next three months, prioritizing patients who cannot undergo neoadjuvant treatment and those that do not require prolonged stays in intensive care, which would not be necessary for ambulatory surgery.</li><li class="elsevierStyleListItem" id="lsti0055">7Priority will be given to those patients who present locally advanced neoplasms with associated complications. In alert scenario II, all types of cancer patients can be operated on, following the prioritization described<a class="elsevierStyleCrossRef" href="#bib0080">16</a>.</li><li class="elsevierStyleListItem" id="lsti0060">8For oncology patients who are candidates for outpatient surgery, such as those with breast cancer or dermatological tumors, specific scales should be used to determine the patient’s global status and complete the prioritization assessments for the procedure, especially that of the Eastern Cooperative Oncology Group (ECOG).</li><li class="elsevierStyleListItem" id="lsti0065">9For the reintroduction of activity in the unit, initially ASA 1 and 2 patients under 60/65 years of age should preferably be included, while avoiding, if possible, patients under treatment with immunosuppressants or corticosteroids<a class="elsevierStyleCrossRef" href="#bib0075">15</a>.</li><li class="elsevierStyleListItem" id="lsti0070">10Initially, it is not recommended to include patients who are institutionalized (nursing homes, penitentiary institutions, or elderly care centers). However, as soon as institutionalized elderly patients are vaccinated (which is foreseeable in the short-term, depending on the vaccination criteria of the ministry<a class="elsevierStyleCrossRef" href="#bib0130">26</a>), these patients could be included preferentially for ambulatory surgery.</li></ul>Protection of healthcare professionals and outpatientsIn order to offer the best service and care to patients, healthcare professionals must be adequately protected<a class="elsevierStyleCrossRefs" href="#bib0060">12,27–29</a>.For effective protection, the following recommendations should be followed:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0075">1The supply of and replacement of personal protective equipment (PPE) must be guaranteed for all staff involved in the ambulatory surgery process.</li><li class="elsevierStyleListItem" id="lsti0080">2Early detection of active SARS-CoV-2 infection among staff is necessary to provide safe care for patients and prevent them from becoming vectors of SARS-CoV-2. Therefore, it is recommended to follow the protocols of the Preventive Medicine Services and Occupational Risk Prevention Services of each hospital<a class="elsevierStyleCrossRef" href="#bib0080">16</a>. These activities range from providing adequate and correct information about the disease to all staff and the prioritization of screening tests to the clinical follow-up of all staff who could be positive and all their contacts, in accordance with the recommendations of the Ministry of Health or the administrations of the Spanish ‘autonomous communities themselves.</li><li class="elsevierStyleListItem" id="lsti0085">3During the pandemic, preoperative screening for active SARS-CoV-2 infection is recommended for all patients who are scheduled to undergo elective surgery<a class="elsevierStyleCrossRefs" href="#bib0075">15,16,27,28</a>,<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a>.</li><li class="elsevierStyleListItem" id="lsti0090">4The choice of tests included in the screening protocol in the form of polymerase chain reaction (PCR), antigens, imaging tests, etc, will vary depending on the epidemiological alert scenario and following the AEC scale as well as the epidemiology of the region or province, through the cumulative incidence of cases diagnosed with SARS-CoV-2 infection in the last 14 days.</li><li class="elsevierStyleListItem" id="lsti0095">5Depending on the epidemiological scenario, all patients will have a PCR test within 72 h of the scheduled date for surgery. The patient will not be allowed in the unit until the result of the PCR is provided.</li><li class="elsevierStyleListItem" id="lsti0100">6Each unit must establish the patient circuit for the PCR test and evaluation of the result before surgery.</li><li class="elsevierStyleListItem" id="lsti0105">7Like other scientific societies, we recommend that the patient and their companion rigorously maintain distancing measures from the day of the preoperative PCR until the date of their surgery to reduce the risk of infection<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>.</li><li class="elsevierStyleListItem" id="lsti0110">8In phase I alert, the epidemiological situation is considered favorable, and practically normal surgical activity can be carried out, maintaining the safety measures agreed upon with preventive medicine. In this situation, and in patients with intermediate risk and surgery, PCR will be omitted<a class="elsevierStyleCrossRef" href="#bib0045">9</a>. In the case of a patient with a positive PCR, as in cases of suspicious symptoms of COVID-19 disease during screening, surgery will be suspended and postponed for at least seven weeks, provided that the pathology and the patient’s status allow<a class="elsevierStyleCrossRef" href="#bib0160">32</a>. The patient will be referred to the primary care doctor, who will establish the appropriate confinement and treatment measures<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>.</li><li class="elsevierStyleListItem" id="lsti0115">9Patients with negative PCR may be scheduled for surgery without the requirement of additional preoperative tests<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>.</li></ul>Preoperative evaluationThe ambulatory surgery consultation can be a second, successive or even the first consultation, in which the patient is added to the surgical waiting list, based on their diagnosis.Recommendations for the consultation follow:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0120">1During the COVID-19 pandemic, “single-visit outpatient surgery consultations are encouraged”, at which time the surgeon will assess the patient, the patient is added to the waiting list, the anesthesiologist and CMA nursing staff evaluate the patient, and preoperative tests are done<a class="elsevierStyleCrossRefs" href="#bib0075">15,32</a>.</li><li class="elsevierStyleListItem" id="lsti0125">2In order to avoid unnecessary visits to the hospital and for the sake of epidemiological screening, a preoperative teleconsultation is used<a class="elsevierStyleCrossRefs" href="#bib0165">33,34</a> for simple screening and subsequent scheduling of the multiple consultation visit to the hospital in the case of first visits, or as a single teleconsultation in successive ones. Therefore, it is necessary to establish a system of communication with the patient (email/telephone/e-consultation) that guarantees compliance with data protection laws.</li><li class="elsevierStyleListItem" id="lsti0130">3In this teleconsultation, through a simple questionnaire (Appendix B, Addendum I) and in the event that one or more of the answers is affirmative, the consultation (or the surgery, if already scheduled) is postponed for a minimum period of seven weeks. The patient is referred to the Primary Care doctor, who will establish the appropriate isolation and follow-up measures.</li><li class="elsevierStyleListItem" id="lsti0135">4In the in-person consultation, a series of recommendations must be followed by both patients and healthcare professionals (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) to guarantee the safety of all<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0140">5The patient’s medical records should reflect whether the consultation was in-person or not. The interview must be recorded in the medical record, indicating that the patient has been informed of the characteristics of the intervention, the associated risks, the patient’s acceptance to participate in it and the consent given by the patient.</li><li class="elsevierStyleListItem" id="lsti0145">6It would be highly efficient and useful to have an electronic signed informed consent (IC), since this would avoid the circulation of paper documents through different departments, although organizing the signature of the IC form will depend on each unit according to its characteristics. Many hospitals are including a specific consent form regarding the current COVID pandemic situation as an addendum to the IC.</li><li class="elsevierStyleListItem" id="lsti0150">7In the case of patients who have had COVID-19 disease, both the decision of their outpatient surgery and the request for additional preoperative tests will be decided on in an individual manner<a class="elsevierStyleCrossRef" href="#bib0075">15</a>.</li></ul><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the sequence for including patients on the ambulatory surgery waiting list.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Major ambulatory surgery unit and operating roomEach unit, depending on its characteristics and resources, must assess the spaces and circuits in order to maintain safe distances in all phases of the process<a class="elsevierStyleCrossRef" href="#bib0010">2</a>.The general protection standards of the ambulatory surgery unit are expressed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Patient receptionWhen the patient arrives at the hospital, it is necessary to confirm that the clinical-epidemiological survey is available in the medical records along with the negative PCR result as well as the verification of the IC. The patient’s temperature is taken, and an identification bracelet will be placed on his/her wrist. Some scientific societies<a class="elsevierStyleCrossRef" href="#bib0075">15</a> recommend that the patient’s accompanying family member also complete the clinical-epidemiological screening survey.Ambulatory surgery unit waiting room<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0155">1Both the patient and family member must wear a surgical mask throughout their stay in the hospital.</li><li class="elsevierStyleListItem" id="lsti0160">2It is recommended to limit the patient to a single companion, who should wait outside the surgical ward to avoid crowding the area.</li><li class="elsevierStyleListItem" id="lsti0165">3The chairs in the waiting rooms of the day surgery units must be 2 m apart.</li><li class="elsevierStyleListItem" id="lsti0170">4Screens are also recommended to inform the patients.</li></ul>Patient preparationThe patient’s personal belongings should be stored in the locker or other pre-determined space and handled only when they are going to be used in order to leave surfaces uncluttered to allow for frequent cleaning and sanitizing. The patient must inform the healthcare personnel if the/she has experienced any changes or symptoms related to the COVID-19 infection.Before taking the patient to the operating room, the nursing staff must complete a checklist to verify the following items<a class="elsevierStyleCrossRef" href="#bib0075">15</a>:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0175">▪The patient is correctly identified by the bracelet and is correctly wearing a mask.</li><li class="elsevierStyleListItem" id="lsti0180">▪Patient temperature</li><li class="elsevierStyleListItem" id="lsti0185">▪Negative clinical-epidemiological screening</li><li class="elsevierStyleListItem" id="lsti0190">▪Negative PCR result</li><li class="elsevierStyleListItem" id="lsti0195">▪Signed IC form (procedure and specific COVID-19)</li><li class="elsevierStyleListItem" id="lsti0200">▪Compliance with preoperative instructions (fasting, etc)</li></ul>Ambulatory surgery operating roomThe operating room should be specific and exclusive for day surgey, and the following general guidelines should be followed.<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0205">1An attempt will be made to prioritize surgical techniques that do not require anesthetic procedures that manipulate the airway, based on the criteria put forth in the patient selection section<a class="elsevierStyleCrossRefs" href="#bib0140">28,30,32</a> and for the types of interventions proposed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</li><li class="elsevierStyleListItem" id="lsti0210">2For surgical or anesthetic procedures that are likely to generate aerosols, it is necessary to use PPE.</li><li class="elsevierStyleListItem" id="lsti0215">3<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists a series of specific measures to be used in the operating room.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia></li></ul>Postoperative recovery unitRecommendations for the post-anesthesia care unit (PACU) are as follows:<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0220">1Patients will continue to wear a mask in the PACU at safe distances from each other.</li><li class="elsevierStyleListItem" id="lsti0225">2As in the operating room, high-flow oxygen administration should be avoided.</li><li class="elsevierStyleListItem" id="lsti0230">3Venturi masks should be avoided, as they diffuse the spread of droplets if the patient coughs and favor the potential aerosolization of the virus.</li><li class="elsevierStyleListItem" id="lsti0235">4The PACU, like the operating room and the phase II unit, should be specific for ambulatory surgery patients.</li></ul>Phase II recovery unitPatients must continue to wear masks, and a safety distance must be maintained between patients. It would be preferable if the patient were alone.Information to relativesA specific circuit must be defined to inform family members while avoiding crowded waiting rooms. Some hospitals have established a real-time information system using applications for mobile devices by which family members are informed of the beginning, duration and completion of the surgical intervention in real time. In times like these that bring about the opportunity for change, it would be highly desirable for the use of devices like these (as well as the electronic signature of the IC) to become generalized in all hospitals in our country.At homeAt discharge, the patient’s family support should be evaluated at discharge, which ideally will also have been considered in the preoperative evaluation.Regular follow-up of the patient will be carried out, with special emphasis on social distancing measures and notification of any complication regarding the patient’s process or the appearance of any symptom related to COVID-19<a class="elsevierStyleCrossRefs" href="#bib0075">15,31</a>.<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> demonstrates the circuit of ambulatory surgery patients.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Training in ambulatory surgery units and SARS-CoV-2In the same way that training in the prevention of infection has become widespread, we cannot forget that medical residents and undergraduate students must continue to learn and complete their rotations<a class="elsevierStyleCrossRef" href="#bib0105">21</a>. In addition, medical training should include the use of new information technologies to make telemedicine and teleconsultation effective<a class="elsevierStyleCrossRefs" href="#bib0100">20,34,35</a>. Another valuable tool is the use of social networks like Twitter as a means to discuss and share scientific evidence<a class="elsevierStyleCrossRef" href="#bib0180">36</a>, which is increasingly demonstrating the importance of global communication to defeat the virus.Final considerationsAt this point in the pandemic, in which surgery must continue, ambulatory surgery is an example of quality, efficient medical care that should be established as the center of scheduled surgical activity, and care circuits should be redesigned around it.The ambulatory surgery unit must be clearly defined as a perfectly separate COVID-free circuit, with a specific team of medical professionals who could be distributed in different work shifts. The safety of patients and staff must be prioritized, and patients and procedures should be selected through the use of guidelines that we have proposed.“Single-visit” preoperative consultations should be encouraged and telemedicine tools promoted, without forgetting undergraduate/resident training and the great opportunities offered by new and developing communication technologies." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1679544" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1679542" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1490236" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1679543" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1490235" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Management of ambulatory surgery in SARS-CoV-2" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection of patients for ambulatory surgery" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of healthcare professionals and outpatients" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Preoperative evaluation" ] 10 => array:3 [ "identificador" => "sec0030" "titulo" => "Major ambulatory surgery unit and operating room" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient reception" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Ambulatory surgery unit waiting room" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Patient preparation" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Ambulatory surgery operating room" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Postoperative recovery unit" ] 5 => array:2 [ "identificador" => "sec0060" "titulo" => "Phase II recovery unit" ] 6 => array:2 [ "identificador" => "sec0065" "titulo" => "Information to relatives" ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "At home" ] ] ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Training in ambulatory surgery units and SARS-CoV-2" ] 12 => array:2 [ "identificador" => "sec0080" "titulo" => "Final considerations" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-02-09" "fechaAceptado" => "2021-04-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1490236" "palabras" => array:3 [ 0 => "Ambulatory surgery" 1 => "COVID-19" 2 => "Safety" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1490235" "palabras" => array:3 [ 0 => "Cirugía mayor ambulatoria" 1 => "COVID-19" 2 => "Seguridad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/o oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La Cirugía Mayor Ambulatoria puede abarcar en su cartera de servicios mas del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no precisa de camas de ingreso y disminuye claramente el riego de infección. Además, es la herramienta que debería de generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia esta generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presenten una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Morales-García D, Docobo-Durantez F, Capitán Vallvey JM, Suarez-Grau JM, Campo-Cimarras ME, González-Vinagre S, et al. Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2. Cir Esp. 2022;100:115–124." ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "Members of the Surgery-AEC-COVID-19 workgroup are listed in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix A</a>." "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "Coordinator of the workgroup: Salvador Morales Conde, Hospital Universitario Virgen del Rocío, Sevilla Members of the workgroup: Estíbaliz Álvarez Peña, Hospital Universitario La Paz, Madrid Mario Álvarez Gallego, Hospital Universitario La Paz, Madrid José Manuel Aranda Narváez, Hospital regional Universitario, Málaga Josep María Badia, Hospital General de Granollers, Barcelona José María Balibrea, Hospital Clinic, Barcelona Sandra García Botella, Hospital Clínico San Carlos, Madrid Xavier Guiro, Hospital Parc Taulí, Barcelona Eloy Espín Basany, Hospital Vall d’Hebron, Barcelona Esteban Martín Antona, Hospital Clínico San Carlos, Madrid Elena Martín Pérez, Hospital Universitario de la Princesa, Madrid Sagrario Martínez Cortijo, Hospital de Talavera de la Reina, Toledo Isabel Pascual Miguelañez, Hospital Universitario La Paz, Madrid Lola Pérez Díaz, Hospital Gregorio Marañón, Madrid José Luis Ramos Rodríguez, Hospital Universitario de Getafe, Madrid Inés Rubio Pérez, Hospital Universitario La Paz, Madrid Raquel Sánchez Santos, Complejo Hospitalario de Vigo, Vigo" "etiqueta" => "Appendix A" "titulo" => "Surgery-AEC-COVID-19 Workgroup" "identificador" => "sec0085" ] 1 => array:4 [ "apendice" => "The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0095" ] ] ] ] "multimedia" => array:9 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2640 "Ancho" => 2333 "Tamanyo" => 228759 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Scheduling sequence of patients for ambulatory surgery." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4167 "Ancho" => 1577 "Tamanyo" => 308723 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient flowchart in ambulatory surgery." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Priority 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Priority 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral or bilateral inguinal hernias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laparoscopic cholecystectomy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Femoral hernias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laparoscopic antireflux surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Umbilical hernias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperparathyroidism surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epigastric hernias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thyroid surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anal fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excision of thyroglossal cyst \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anal and perianal simple fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excision of branchial fistulae or cysts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemorrhoids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adrenal surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Condyloma acuminata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laparoscopic splenectomy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pilonidal sinus (sacrococcygeal cysts) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excision of lipomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soft tissue biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Venous reservoirs (placement and/or removal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Small incisional hernias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Varicose veins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implantation of peritoneal dialysis catheters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rectal polyps \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urgent surgery (appendicitis, abscess drainage, etc) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast surgery (benign and/or malignant pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2857065.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of General Ambulatory Surgery procedures, listed by priority." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "WHO: World Health Organization." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for staff \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-The waiting room should be organized to guarantee a safe distance between people (2 m). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Insist on the compliance with hand hygiene measures (WHO 5 moments) in each hospital. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Appointments should be scheduled with enough time in between to avoid crowded waiting rooms. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Avoid using rings, watches, bracelets, nail polish or artificial nails. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Patients should wear surgical masks that cover the nose and mouth. If another type of mask is worn, or a respirator with an exhalation valve, this will be substituted or covered with a surgical mask. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Avoid or, if possible, delay inspecting wounds until immediately before surgery or treating wounds that entail a risk for splattering or aerosols (for example, when assessing the upper airway [Malampati]). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Ensure that patients clean their hands with an alcohol-based product upon entering the consultation. If he/she is wearing gloves, they should be removed and alcohol-based gel applied immediately. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Use short-sleeved work uniform (scrubs). Avoid using scrubs from the surgical unit in other areas of the hospital. Use clean scrubs each day and follow the clothing recommendations of the hospital. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Avoid patients being accompanied except under justified circumstances, in which case the same measures will be followed. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Use personal protection equipment (PPE) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Selectively clean the patient contact surface areas between patients. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2857064.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for patients and staff in the ambulatory surgery consultations." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">General rules for protection in the ambulatory surgery unit \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Patients, family members and healthcare staff should have access to hydroalcoholic solution dispensers, which should be correctly indicated. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Patients and family members should wear surgical or FFP2 masks, following mandates that are in effect at the given time. Fabric masks will not be allowed. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-A safe distance will be established with patients before entering the OR, depending on the architecture of the facilities. The postoperative recovery and phase II recovery units of each hospital should be clearly organized for strict compliance with distancing measures. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-All staff of the unit should have PPE, which will be used rationally and depending on the surgical procedure or anesthesia technique to be performed. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-In terms of the cleanliness of the installations, routine cleaning and disinfection protocols should be followed, with more frequent disinfection of high-traffic patient and staff areas. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2857066.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General rules for protection in the ambulatory surgery unit." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "WHO: World Health Organization." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for the ambulatory surgery operating room \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Strictly observe the hand hygiene protocol and recommendations in the healthcare area (5 moments of the WHO) at each hospital. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-It is especially important not to use surgery unit scrubsin consultation areas or the hospitalization wards, and vice versa. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Use FFP3, FFP2 or N95 masks (if the mask has an exhalation valve, this should be covered with a surgical mask) and integral eye protection for examinations or procedures that generate aerosols. Use disposable gowns. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Add screen-type protection for maneuvers that could cause splattering, and use disposable gowns. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Limit the number of people in the operating room. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Keep doors closed to maintain positive pressure, and schedule procedures with enough time in between so that any aerosols generated have time to deposit and be cleaned. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Avoid the administration of high-flow oxygen and, if administered, always under a surgical mask. If oxygen is necessary, nasal cannulae are best. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2857063.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for the ambulatory surgery operating room." ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 50902 ] ] 7 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.docx" "ficheroTamanyo" => 62588 ] ] 8 => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 750 "Ancho" => 1333 "Tamanyo" => 159316 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de sanidad. Centro de coordinación de Alertas y Emergencias sanitarias. Actualización n. 301. Enfermedad por el coronavirus (COVID-19). 29.01.2021 (datos consolidados a las 14:00 horas del 29.01.2021). Situación en España. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_304_COVID-19.pdf">https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_304_COVID-19.pdf</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M. Álvarez Gallego" 1 => "S. Gortázar de Las Casas" 2 => "I. Pascual Migueláñez" 3 => "I. Rubio-Pérez" 4 => "C. Barragán Serrano" 5 => "E. Álvarez Peña" 6 => "J. Díaz Domínguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.04.001" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2020" "volumen" => "98" "paginaInicial" => "320" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32336467" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of patients with COVID-19 infection. Recommendations of the Spanish Association of Surgeons" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Balibrea" 1 => "J.M. Badia" 2 => "I. Rubio Pérez" 3 => "E.M. Antona" 4 => "E. Álvarez-Peña" 5 => "S. García-Botella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.03.001" "Revista" => array:5 [ "tituloSerie" => "Cir Esp" "fecha" => "2020" "volumen" => "98" "paginaInicial" => "251" "paginaFinal" => "259" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posicionamiento del Grupo de Trabajo «Cirugía-AEC-COVID» de la Asociación Española de Cirujanos sobre la planiﬁcación de la actividad quirúrgica durante la segunda ola de la pandemia por SARS-CoV-2: la cirugía debe continuar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Balibrea" 1 => "S. Morales-Conde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.10.013" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2021" "volumen" => "99" "paginaInicial" => "77" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33228971" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Fowler" 1 => "T.D. Dobbs" 2 => "Y.I. Wan" 3 => "R. Laloo" 4 => "S. Hui" 5 => "D. Nepogodiev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bjs/znaa012" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2020" "volumen" => "108" "paginaInicial" => "97" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33640927" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective cohort study of the impact of covid19 world pandemic on the management of emergency surgical pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Perea Del Pozo" 1 => "D. Aparicio-Sánchez" 2 => "F. Hinojosa Ramírez" 3 => "F. Pareja Ciuró" 4 => "V.D. Muñoz-Cruzado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.11918" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2020" "volumen" => "107" "paginaInicial" => "e463" "paginaFinal" => "e464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32790177" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A dynamic scale for surgical activity (DYSSA) stratification during the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Morales-Conde" 1 => "A. Balla" 2 => "M. Álvarez Gallego" 3 => "J.M. Aranda-Narváez" 4 => "J.M. Badia" 5 => "J.M. Balibrea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.11870" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2020" "volumen" => "107" "paginaInicial" => "e425" "paginaFinal" => "e426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32735347" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for acting in elective and urgent thoracic surgery during SARS-CoV-2 pandemic. Spanish Society of Thoracic Surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.R. Jarabo" 1 => "N. Martínez" 2 => "A. Cabañero" 3 => "S. Call" 4 => "J.L. Campo-Cañaveral" 5 => "Á Cilleruelo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.08.005" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2020" "volumen" => "98" "paginaInicial" => "574" "paginaFinal" => "581" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33040975" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and SARS-CoV-2: considerations on bariatric surgery and recommendations for the start of surgical activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Sánchez Santos" 1 => "A. García Ruiz de Gordejuela" 2 => "I. Breton Lesmes" 3 => "A. Lecube Torelló" 4 => "V. Moizé Arcone" 5 => "J.J. Arroyo Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.06.005" "Revista" => array:7 [ "tituloSerie" => "Cir Esp" "fecha" => "2021" "volumen" => "99" "paginaInicial" => "4" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32921419" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613624162" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones de actuación en cirugía oncológica hepatobiliopancreática durante la pandemia COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. García-Botella" 1 => "M.A. Gómez-Bravo" 2 => "M. Di Martino" 3 => "M. Gastaca" 4 => "E. Martín-Pérez" 5 => "S. Sánchez-Cabús" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2020.10.010" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2020" "volumen" => "99" "paginaInicial" => "174" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33341242" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "COVIDSurg Collaborative" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(20)31182-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2020" "volumen" => "396" "paginaInicial" => "27" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32479829" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American College of Surgeons Responds to COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.W. Rusch" 1 => "S.D. Wexner" 2 => "American College of Surgeons COVID-19 Communications Committee" 3 => "Board of Regents, and Officers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jamcollsurg.2020.06.020" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Surg" "fecha" => "2020" "volumen" => "23" "paginaInicial" => "490" "paginaFinal" => "496" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elective Surgery during the Covid-19 Pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Wu" 1 => "C.R. Smith" 2 => "B.T. Lembcke" 3 => "T.B.D. Ferreira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMclde2028735" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "383" "paginaInicial" => "1787" "paginaFinal" => "1790" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33113301" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures. [Accessed 9 May 2020]. Available from: <a target="_blank" href="https://www.facs.org/covid-19/clinical-guidance/triage">https://www.facs.org/covid-19/clinical-guidance/triage</a>." ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Junta directiva de ASECMA. Recomendaciones para la reapertura de las unidades de CMA durante el periodo de transición de la pandemia por el COVID-19 (SARS-CoV-2)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Archilla" 1 => "M. Zaballos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir May Amb" "fecha" => "2020" "volumen" => "25" "paginaInicial" => "25" "paginaFinal" => "38" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Documento técnico. Recomendaciones para la programación de cirugía en condiciones de seguridad durante la pandemia covid-19. Versión 14 de diciembre 2020. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Cirugia_electiva.pdf">https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Cirugia_electiva.pdf</a>." ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad y Consumo. Manual Unidad de Cirugía Mayor Ambulatoria. Estándares y recomendaciones. Available from: <a target="_blank" href="https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/guiaCMA.pdf">https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/guiaCMA.pdf</a>." ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía Mayor Ambulatoria. Eficiencia en la asistencia sanitaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Porrero" 1 => "B. Porrero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2015" "editorial" => "Edita Win2win worldwide" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major ambulatory surgery: where we are and where are we going" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Capitán Valvey" 1 => "S. González Vinagre" 2 => "F. Barreiro Morandeira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2017.04.005" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2018" "volumen" => "96" "paginaInicial" => "1" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28683862" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ambulatory Surgery and COVID-10 pandemic. Opportunity for chance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Docobo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir Anda" "fecha" => "2020" "volumen" => "31" "paginaInicial" => "134" "paginaFinal" => "135" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La ASAC en la pandemia COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Docobo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cir Anda" "fecha" => "2020" "volumen" => "31" "paginaInicial" => "352" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "BOJA 183, lunes 21 de septiembre de 2020. Acuerdo de 15 de septiembre de 2020, del Consejo de Gobierno, por el que toma conocimiento de la actuación del estudio realizado por la Consejería de Salud y Familias sobre los recursos asistenciales en cada provincia andaluza ante el escenario de llegar a los 3.000 pacientes ingresados por COVID-19. Available from: <a target="_blank" href="https://www.juntadeandalucia.es/boja/2020/183/BOJA20-183-00013-10403-01_00177739.pdf">https://www.juntadeandalucia.es/boja/2020/183/BOJA20-183-00013-10403-01_00177739.pdf</a>." ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "BOJA extraordinario n. 73, viernes 30 de octubre de 2020. Orden de 29 de octubre de 2020, por la que se establecen los niveles de alerta sanitaria y se adoptan medidas temporales y excepcionales por razón de salud pública en Andalucía, para la contención de la COVID-19. Available from: <a target="_blank" href="https://www.juntadeandalucia.es/boja/2020/573/BOJA20-573-00032-13086-01_00180355.pdf">https://www.juntadeandalucia.es/boja/2020/573/BOJA20-573-00032-13086-01_00180355.pdf</a>." ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19 Guidelines for Triage of Cancer Surgery Patients. ACS website" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ACS" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.facs.org/covid-19/clinical-guidance/elective-case/cancer-surgery" "fecha" => "2020" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Asociación Española de Cirujanos. Recomendaciones generales en cirugía oncológica. [Accessed 27 April 2020] Available from: <a target="_blank" href="https://www.aecirujanos.es/files/noticias/152/documentos/Pacientes_oncologicos_y_covid19_v2(1).pdf">https://www.aecirujanos.es/files/noticias/152/documentos/Pacientes_oncologicos_y_covid19_v2(1).pdf</a>." ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Estrategia de vacunación frente a COVID-19 en España. Grupo de Trabajo Técnico de Vacunación COVID-19 de la ponencia de programa y registro de vacunaciones. Actualización 1. 18 de diciembre de 2020. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/covid19/docs/COVID-19_Actualizacion1_EstrategiaVacunacion.pdf">https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/covid19/docs/COVID-19_Actualizacion1_EstrategiaVacunacion.pdf</a>." ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Zhang" 1 => "S. Liu" 2 => "M.I. Xiang" 3 => "S. Li" 4 => "D. Zhao" 5 => "C. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11684-020-0765-x" "Revista" => array:6 [ "tituloSerie" => "Front Med" "fecha" => "2020" "volumen" => "14" "paginaInicial" => "229" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32212058" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precautions for operation room team members during the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Forrester" 1 => "A.K. Nassar" 2 => "P.M. Maggio" 3 => "M.T. Hawn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jamcollsurg.2020.03.030" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Surg" "fecha" => "2020" "volumen" => "230" "paginaInicial" => "1098" "paginaFinal" => "1101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32247836" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19: How can a department of general surgery survive in a pandemic?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Guerci" 1 => "A. Maffioli" 2 => "A.A. Bondurri" 3 => "L. Ferrario" 4 => "F. Lazzarin" 5 => "P. Danelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surg.2020.03.012" "Revista" => array:6 [ "tituloSerie" => "Surgery" "fecha" => "2020" "volumen" => "167" "paginaInicial" => "909" "paginaFinal" => "911" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32299626" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Dexter" 1 => "M.C. Parra" 2 => "J.R. Brown" 3 => "R.W. Loftus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000004829" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2020" "volumen" => "131" "paginaInicial" => "37" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32217947" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Covid-19: patients should self-isolate for two weeks before elective care, trusts are told" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Z. Kmietowicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.m1991" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2020" "volumen" => "369" "paginaInicial" => "m1991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32414707" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0959804916322109" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Nepogodiev" 1 => "G. Baiocchi" 2 => "R. Blanco-Colino" 3 => "F. Wuraola" 4 => "D. Ghosh" 5 => "R. Gujjuri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.15458" "Revista" => array:4 [ "tituloSerie" => "Anaesthesia" "fecha" => "2021" "paginaInicial" => "1" "paginaFinal" => "11" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19: role of ambulatory surgery facilities in this global pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Rajan" 1 => "G.P. Joshi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000004847" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2020" "volumen" => "131" "paginaInicial" => "31" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32243288" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ICT applied to day surgery management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Argente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir May Amb" "fecha" => "2015" "volumen" => "20" "paginaInicial" => "83" "paginaFinal" => "87" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of home monitoring via mobile app on the number of in-person visits following ambulatory surgery: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.A.C.P. Armstrong" 1 => "M. Brown" 2 => "B. Beber" 3 => "J.L. Semple" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamasurg.2017.0111" "Revista" => array:6 [ "tituloSerie" => "JAMA Surg" "fecha" => "2017" "volumen" => "152" "paginaInicial" => "622" "paginaFinal" => "627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28329223" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "#Some4Surgery: una plataforma para promover la educación global" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Landaluce" 1 => "J. Mayol" 2 => "D. Morales" 3 => "B. Estraviz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir And" "fecha" => "2020" "volumen" => "31" "paginaInicial" => "32" "paginaFinal" => "37" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000291/v1_202203130532/en/main.assets" "Apartado" => array:4 [ "identificador" => "7418" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000010000000003/v1_202203130532/S2173507722000291/v1_202203130532/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000291?idApp=UINPBA00004N"]

Statistics

Special article

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic

Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2

Dieter Morales-Garcíaa,b,

Corresponding author

dms11@me.com

Corresponding author.

, Fernando Docobo-Duranteza,c, J.M. Capitán Vallveya,d, Juan Manuel Suarez-Graua,e, María Eugenia Campo-Cimarrasa,f, Salustiano González-Vinagrea,g, Luis Antonio Hidalgo-Graua,h, J.M. Puigcercos-Fustéa,i, Cristóbal Zaragoza-Fernándeza,j, Zoraida Valera-Sáncheza,k, Vicente Vega-Ruiza,l, Surgery-AEC-COVID-19 workgroup ◊

a Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, Spain

b Hospital Universitario «Marqués de Valdecilla», Instituto de Investigación IDIVAL, Santander, Spain

c Comité Científico, Asociación Andaluza de Cirujanos, Andalucía, Spain

d Hospital Universitario de Jaén, Jaén, Spain

e Hospital Riotinto, Huelva, Spain

f Hospital Txagorritxu, Vitoria, Spain

g Hospital Universitario de Santiago, Santiago de Compostela, Spain

h Hospital de Mataró, Barcelona, Spain

i Hospital Dos de Mayo, Barcelona, Spain

j Hospital General Universitario de Valencia, Valencia, Spain

k Hospital Universitario Virgen Macarena, Sevilla, Spain

l Hospital Universitario Puerto Real, Cádiz, Spain

Read

1142

Times
was read the article

100

Total PDF

1042

Total HTML

Share statistics

 array:24 [
  "pii" => "S2173507722000291"
  "issn" => "21735077"
  "doi" => "10.1016/j.cireng.2022.02.014"
  "estado" => "S300"
  "fechaPublicacion" => "2022-03-01"
  "aid" => "2538"
  "copyright" => "AEC"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Cir Esp. 2022;100:115-24"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0009739X21001603"
      "issn" => "0009739X"
      "doi" => "10.1016/j.ciresp.2021.04.012"
      "estado" => "S300"
      "fechaPublicacion" => "2022-03-01"
      "aid" => "2538"
      "copyright" => "AEC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Cir Esp. 2022;100:115-24"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:14 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
        "titulo" => "Consenso de la secci&#243;n de cirug&#237;a mayor ambulatoria de la Asociaci&#243;n Espa&#241;ola de Cirujanos sobre el papel de la cirug&#237;a mayor ambulatoria en la pandemia SARS-CoV-2"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:3 [
          0 => "es"
          1 => "es"
          2 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "115"
            "paginaFinal" => "124"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 1
          "multimedia" => array:5 [
            "identificador" => "fig0015"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => false
            "mostrarDisplay" => true
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "fx1.jpeg"
                "Alto" => 750
                "Ancho" => 1333
                "Tamanyo" => 181358
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Dieter Morales-Garc&#237;a, Fernando Docobo-Durantez, J&#46;M&#46; Capit&#225;n Vallvey, Juan Manuel Suarez-Grau, Mar&#237;a Eugenia Campo-Cimarras, Salustiano Gonz&#225;lez-Vinagre, Luis Antonio Hidalgo-Grau, J&#46;M&#46; Puigcercos-Fust&#233;, Crist&#243;bal Zaragoza-Fern&#225;ndez, Zoraida Valera-S&#225;nchez, Vicente Vega-Ruiz"
            "autores" => array:12 [
              0 => array:2 [
                "nombre" => "Dieter"
                "apellidos" => "Morales-Garc&#237;a"
              ]
              1 => array:2 [
                "nombre" => "Fernando"
                "apellidos" => "Docobo-Durantez"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Capit&#225;n Vallvey"
              ]
              3 => array:2 [
                "nombre" => "Juan Manuel"
                "apellidos" => "Suarez-Grau"
              ]
              4 => array:2 [
                "nombre" => "Mar&#237;a Eugenia"
                "apellidos" => "Campo-Cimarras"
              ]
              5 => array:2 [
                "nombre" => "Salustiano"
                "apellidos" => "Gonz&#225;lez-Vinagre"
              ]
              6 => array:2 [
                "nombre" => "Luis Antonio"
                "apellidos" => "Hidalgo-Grau"
              ]
              7 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Puigcercos-Fust&#233;"
              ]
              8 => array:2 [
                "nombre" => "Crist&#243;bal"
                "apellidos" => "Zaragoza-Fern&#225;ndez"
              ]
              9 => array:2 [
                "nombre" => "Zoraida"
                "apellidos" => "Valera-S&#225;nchez"
              ]
              10 => array:2 [
                "nombre" => "Vicente"
                "apellidos" => "Vega-Ruiz"
              ]
              11 => array:1 [
                "colaborador" => "Grupo de Trabajo CIRUGIA-AEC-COVID-19"
              ]
            ]
          ]
        ]
        "resumen" => array:1 [
          0 => array:3 [
            "titulo" => "Graphical abstract"
            "clase" => "graphical"
            "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0015"></elsevierMultimedia></p></span>"
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173507722000291"
          "doi" => "10.1016/j.cireng.2022.02.014"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000291?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21001603?idApp=UINPBA00004N"
      "url" => "/0009739X/0000010000000003/v1_202203020514/S0009739X21001603/v1_202203020514/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173507722000266"
    "issn" => "21735077"
    "doi" => "10.1016/j.cireng.2022.02.011"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "2480"
    "copyright" => "AEC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Cir Esp. 2022;100:125-32"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:14 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly&#46; Can we do it safely&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:3 [
        0 => "en"
        1 => "en"
        2 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "125"
          "paginaFinal" => "132"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Duodenopancreatectom&#237;a por adenocarcinoma ductal de p&#225;ncreas en ancianos&#46; &#191;Podemos asumirla con seguridad&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 1
        "multimedia" => array:5 [
          "identificador" => "fig0015"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => false
          "mostrarDisplay" => true
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "fx1.jpeg"
              "Alto" => 886
              "Ancho" => 1575
              "Tamanyo" => 191163
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Pine&#241;o-Flores, David Ambrona-Zafra, Jose Carlos Rodr&#237;guez-Pino, Carla Soldevila-Verdeguer, Elias Palma-Zamora, Francesc Xavier Molina-Romero, Jose Miguel Mor&#243;n-Canis, Francesc Xavier Gonz&#225;lez-Argente, Rafael Morales-Soriano"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Pine&#241;o-Flores"
            ]
            1 => array:2 [
              "nombre" => "David"
              "apellidos" => "Ambrona-Zafra"
            ]
            2 => array:2 [
              "nombre" => "Jose Carlos"
              "apellidos" => "Rodr&#237;guez-Pino"
            ]
            3 => array:2 [
              "nombre" => "Carla"
              "apellidos" => "Soldevila-Verdeguer"
            ]
            4 => array:2 [
              "nombre" => "Elias"
              "apellidos" => "Palma-Zamora"
            ]
            5 => array:2 [
              "nombre" => "Francesc Xavier"
              "apellidos" => "Molina-Romero"
            ]
            6 => array:2 [
              "nombre" => "Jose Miguel"
              "apellidos" => "Mor&#243;n-Canis"
            ]
            7 => array:2 [
              "nombre" => "Francesc Xavier"
              "apellidos" => "Gonz&#225;lez-Argente"
            ]
            8 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Morales-Soriano"
            ]
          ]
        ]
      ]
      "resumen" => array:1 [
        0 => array:3 [
          "titulo" => "Graphical abstract"
          "clase" => "graphical"
          "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0015"></elsevierMultimedia></p></span>"
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0009739X21000294"
        "doi" => "10.1016/j.ciresp.2021.01.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21000294?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000266?idApp=UINPBA00004N"
    "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000266/v1_202203130532/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173507722000230"
    "issn" => "21735077"
    "doi" => "10.1016/j.cireng.2021.06.021"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "2573"
    "copyright" => "AEC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Cir Esp. 2022;100:113-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Textbook outcome&#58; A new quality tool"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "113"
          "paginaFinal" => "114"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "<span class="elsevierStyleItalic">Textbook outcome</span> &#40;resultado de libro&#41;&#58; una nueva herramienta de gesti&#243;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jose M&#46; Ramia, Victoriano Soria-Aledo"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Jose M&#46;"
              "apellidos" => "Ramia"
            ]
            1 => array:2 [
              "nombre" => "Victoriano"
              "apellidos" => "Soria-Aledo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0009739X21002153"
        "doi" => "10.1016/j.ciresp.2021.06.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X21002153?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000230?idApp=UINPBA00004N"
    "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000230/v1_202203130532/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
    "titulo" => "Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "115"
        "paginaFinal" => "124"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Dieter Morales-Garc&#237;a, Fernando Docobo-Durantez, J&#46;M&#46; Capit&#225;n Vallvey, Juan Manuel Suarez-Grau, Mar&#237;a Eugenia Campo-Cimarras, Salustiano Gonz&#225;lez-Vinagre, Luis Antonio Hidalgo-Grau, J&#46;M&#46; Puigcercos-Fust&#233;, Crist&#243;bal Zaragoza-Fern&#225;ndez, Zoraida Valera-S&#225;nchez, Vicente Vega-Ruiz"
        "autores" => array:12 [
          0 => array:4 [
            "nombre" => "Dieter"
            "apellidos" => "Morales-Garc&#237;a"
            "email" => array:1 [
              0 => "dms11@me.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Fernando"
            "apellidos" => "Docobo-Durantez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Capit&#225;n Vallvey"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Juan Manuel"
            "apellidos" => "Suarez-Grau"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a Eugenia"
            "apellidos" => "Campo-Cimarras"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Salustiano"
            "apellidos" => "Gonz&#225;lez-Vinagre"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Luis Antonio"
            "apellidos" => "Hidalgo-Grau"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Puigcercos-Fust&#233;"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Crist&#243;bal"
            "apellidos" => "Zaragoza-Fern&#225;ndez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Zoraida"
            "apellidos" => "Valera-S&#225;nchez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Vicente"
            "apellidos" => "Vega-Ruiz"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          11 => array:2 [
            "colaborador" => "Surgery-AEC-COVID-19 workgroup"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:12 [
          0 => array:3 [
            "entidad" => "Secci&#243;n de Cirug&#237;a Mayor Ambulatoria&#44; Asociaci&#243;n Espa&#241;ola de Cirujanos&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Universitario &#171;Marqu&#233;s de Valdecilla&#187;&#44; Instituto de Investigaci&#243;n IDIVAL&#44; Santander&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Comit&#233; Cient&#237;fico&#44; Asociaci&#243;n Andaluza de Cirujanos&#44; Andaluc&#237;a&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Universitario de Ja&#233;n&#44; Ja&#233;n&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Hospital Riotinto&#44; Huelva&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Hospital Txagorritxu&#44; Vitoria&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Hospital Universitario de Santiago&#44; Santiago de Compostela&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Hospital de Matar&#243;&#44; Barcelona&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Hospital Dos de Mayo&#44; Barcelona&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Hospital Universitario Virgen Macarena&#44; Sevilla&#44; Spain"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Hospital Universitario Puerto Real&#44; C&#225;diz&#44; Spain"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Consenso de la secci&#243;n de cirug&#237;a mayor ambulatoria de la Asociaci&#243;n Espa&#241;ola de Cirujanos sobre el papel de la cirug&#237;a mayor ambulatoria en la pandemia SARS-CoV-2"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 1
      "multimedia" => array:5 [
        "identificador" => "fig0015"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx1.jpeg"
            "Alto" => 750
            "Ancho" => 1333
            "Tamanyo" => 159316
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In February 2021&#44; the world is still mired in the pandemic due to the SARS-CoV-2 virus&#46; Spain in particular<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is suffering the consequences&#44; as it is immersed in a third wave that is forcing us to suspend surgeries of all kinds &#40;except emergencies&#41; in many hospitals of our country&#46; However&#44; despite this serious situation&#44; we cannot and should not forget that&#44; in addition to COVID-19&#44; many patients have surgical problems&#44; etc&#44; that have an even greater effect on their lives&#46; Elective surgical activity must prioritize the safety of patients and healthcare professionals throughout the process<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; However&#44; as stated by Balibrea<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; surgery must continue&#46; We cannot let patients with non-COVID pathology be neglected&#44; patients who have been waiting for months for a surgical intervention that in many instances affects their family life&#44; social life and occupational life in addition to their health&#46; Moving forward&#44; this situation should make us reflect on all the possible lines of action<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; and ambulatory surgery is a process that offers alternatives&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As doctors and as part of the society involved&#44; we collaborate in the search for the most appropriate solutions in these times of urgency&#44; in which all available resources have been made available to control the pandemic&#46; As surgeons&#44; we have developed our role in these special circumstances&#44; with strategic&#44; instrumental and personal support&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This has led to a profound change in healthcare activity&#44; from the transfer of surgical hospital beds to care for patients admitted due to COVID-19&#44; to establishing online consultations or teleconsultations to avoid infecting other patients&#44; as well as the cancellation of scheduled surgeries&#44; operating exclusively on individuals with urgent or serious oncological conditions that cannot be postponed&#46; In certain cases&#44; this has meant that patients have come to the Emergency Department in not exactly the best condition<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The evidence existing to date&#44; both on the infection and on the surgical approach to it&#44; has been intensively and continuously shared and updated in a short space of time by the Spanish Association of Surgeons &#40;AEC&#41; and its divisions<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;7&#8211;10</span></a>&#44; in permanent contact with other scientific societies<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;16</span></a>&#46; This has made it possible to treat a large number of patients and has put the entire Spanish healthcare system to a great test of strength&#44; and the response of all health professionals is being exceptional&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this situation&#44; there is much long-term scientific evidence to demonstrate that ambulatory surgery is a safe&#44; effective and efficient system for resolving the processes included in the portfolio of services offered<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">From the Ambulatory Surgery Division of the AEC&#44; on behalf of all the surgeons who perform day surgery in our country&#44; we believe that this is an example of quality and efficiency of care that should be established as the center of scheduled surgical activity in these difficult times&#46; Surgical treatment circuits and the function of services should be redesigned to achieve outpatient treatment rates in line with those established in our setting&#46; This can and should be a priority solution to the great demand for surgery that lies ahead after the COVID-19 epidemic<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The role of scientific societies in coordination with healthcare authorities is crucial in dealing with this pathology&#46; When there is good coordination and receptivity&#44; the suggestions of scientific societies&#44; in this case the Spanish Association of Major Ambulatory Surgery &#40;ASECMA&#41; and its Board of Directors&#44; have managed to improve the resolutions published in different government bulletins based on the existing evidence&#44; providing solutions<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> and giving day surgery the significant role it should play at this time&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">From the outset&#44; the AEC&#44; its divisions and the Surgery-AEC-COVID-19 workgroup<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; together with other societies &#40;including ASECMA&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; have drawn up recommendations to be used as a guideline for the development of local protocols<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Following these recommendations and adapting them to the day surgery setting&#44; we propose a series of actions to be able to safely continue operating with guaranteed safety for patients&#44; which must be reviewed as the epidemic evolves&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Management of ambulatory surgery in SARS-CoV-2</span><p id="par0045" class="elsevierStylePara elsevierViewall">The ambulatory surgery unit must be clearly defined in a perfectly separated COVID-free environment&#44; regardless of whether it forms part of the physical structure of the hospital or is an isolated unit<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The management recommendations are as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0055" class="elsevierStylePara elsevierViewall">There must be a specific day surgery committee within the hospital&#8217;s COVID surgical committee&#44; with representation of specialists and units involved in day surgery&#44; who&#44; as experts&#44; advise on decision-making for &#8216;<span class="elsevierStyleBold"><span class="elsevierStyleItalic">what&#44; how and in what way</span></span>&#8217; while taking into account the epidemiological risk and the resources available&#46; This sort of plan is very important at this time&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0060" class="elsevierStylePara elsevierViewall">Similarly&#44; the ambulatory surgery circuit must be clearly differentiated in the hospital &#40;regardless of the unit type available&#41;&#44; from the hospital access to the consultations and in the surgical area itself&#44; as well as the location of the ambulatory surgery unit&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0065" class="elsevierStylePara elsevierViewall">It is highly recommended that the consultation for surgery&#44; nursing and anesthesia be simultaneous and on the same day that the patient is included on the surgical waiting list&#44; in the so-called &#8220;<span class="elsevierStyleBold"><span class="elsevierStyleItalic">one-step consultation</span></span>&#8221;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the management of people&#44; at this time it would be advisable to have a specific team from and for ambulatory surgery&#44; in which the professionals could be distributed in work shifts in order to be able to immediately cover any contingency without negatively affecting treatment or continuity of care&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Selection of patients for ambulatory surgery</span><p id="par0075" class="elsevierStylePara elsevierViewall">The selection of patients for ambulatory surgery based on medical&#44; social or day surgery criteria&#44; etc&#44; is perfectly defined for each procedure within the different guidelines<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; as well as in the intra-hospital protocols of each institution based on its portfolio of services&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the current situation&#44; <span class="elsevierStyleBold"><span class="elsevierStyleItalic">we should be able to identify which patients and which pathologies require surgery&#44; and with what level of priority</span></span>&#46; To this end&#44; the guidelines of the American College of Surgeons &#40;ACS&#41; and the AEC can be used as a reference<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;16&#44;24&#44;25</span></a>&#44; and also for oncology patients&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We must take into account the pathology that is the cause of the intervention&#44; the procedure and the patient&#8217;s status&#46; The AEC proposes a dynamic scale that defines 5 phases in the evolution of the COVID-19 pandemic as it waxes and wanes<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The Ambulatory Surgery Division proposes establishing surgical priorities based on the following factors&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1</span><p id="par0095" class="elsevierStylePara elsevierViewall">In the current situation&#44; criteria such as priority at the time of inclusion &#40;standard&#44; preferential and urgent&#41; should be used to indicate the surgery of patients who have been included preferentially or urgently&#44; which is done based on strictly objective criteria&#44; as well as the current situation of the patient&#44; which may have changed since their inclusion on the waiting list&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2</span><p id="par0100" class="elsevierStylePara elsevierViewall">Surgical activity will be determined by the phase of the pandemic in which we find ourselves&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3</span><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> proposes a prioritization of interventions based on diagnosis&#44; such as <span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#8216;priority 1&#8217; or &#8216;priority 2&#8217; diagnoses</span></span>&#46; This is basically done according to the degree of complexity and depending on whether the surgical intervention can be performed with an anesthetic technique that does not require instrumental manipulation of the airway&#46; Also&#44; we must not forget that&#44; although day surgery encompasses moderately complex procedures&#44; more and more complex patients are now being treated&#44; and surgeries are being performed with greater difficulty&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">4</span><p id="par0110" class="elsevierStylePara elsevierViewall">In the current situation&#44; the immediate incorporation of new procedures &#40;not previously included&#44; or no previous experience&#41; in the portfolio of services is not recommended&#44; but this will depend on each center and day surgery team&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">5</span><p id="par0115" class="elsevierStylePara elsevierViewall">The patient&#8217;s risk&#44; classified according to predictive factors for 30-day mortality<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; may be high&#58; male patients&#44; &#62;70 years&#44; with significant associated comorbidity &#40;American Society of Anesthesiologists &#91;ASA&#93; classification III or IV&#41; and in need of major surgery for oncological pathology&#59; or moderate in the remaining situations<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;16</span></a>&#46; <span class="elsevierStyleBold"><span class="elsevierStyleItalic">By definition&#44; the risk of ambulatory surgery procedures is moderate or low</span></span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">6</span><p id="par0120" class="elsevierStylePara elsevierViewall">In the case of cancer patients in alert stage III&#44; we should operate on those individuals whose treatment cannot be delayed because their survival could worsen within the next three months&#44; prioritizing patients who cannot undergo neoadjuvant treatment and those that do not require prolonged stays in intensive care&#44; which would not be necessary for ambulatory surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">7</span><p id="par0125" class="elsevierStylePara elsevierViewall">Priority will be given to those patients who present locally advanced neoplasms with associated complications&#46; In alert scenario II&#44; all types of cancer patients can be operated on&#44; following the prioritization described<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">8</span><p id="par0130" class="elsevierStylePara elsevierViewall">For oncology patients who are candidates for outpatient surgery&#44; such as those with breast cancer or dermatological tumors&#44; specific scales should be used to determine the patient&#8217;s global status and complete the prioritization assessments for the procedure&#44; especially that of the Eastern Cooperative Oncology Group &#40;ECOG&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">9</span><p id="par0135" class="elsevierStylePara elsevierViewall">For the reintroduction of activity in the unit&#44; initially ASA 1 and 2 patients under 60&#47;65 years of age should preferably be included&#44; while avoiding&#44; if possible&#44; patients under treatment with immunosuppressants or corticosteroids<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">10</span><p id="par0140" class="elsevierStylePara elsevierViewall">Initially&#44; it is not recommended to include patients who are institutionalized &#40;nursing homes&#44; penitentiary institutions&#44; or elderly care centers&#41;&#46; However&#44; as soon as institutionalized elderly patients are vaccinated &#40;which is foreseeable in the short-term&#44; depending on the vaccination criteria of the ministry<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#41;&#44; these patients could be included preferentially for ambulatory surgery&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of healthcare professionals and outpatients</span><p id="par0145" class="elsevierStylePara elsevierViewall">In order to offer the best service and care to patients&#44; healthcare professionals must be adequately protected<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;27&#8211;29</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">For effective protection&#44; the following recommendations should be followed&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">1</span><p id="par0155" class="elsevierStylePara elsevierViewall">The supply of and replacement of personal protective equipment &#40;PPE&#41; must be guaranteed for all staff involved in the ambulatory surgery process&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">2</span><p id="par0160" class="elsevierStylePara elsevierViewall">Early detection of active SARS-CoV-2 infection among staff is necessary to provide safe care for patients and prevent them from becoming vectors of SARS-CoV-2&#46; Therefore&#44; it is recommended to follow the protocols of the Preventive Medicine Services and Occupational Risk Prevention Services of each hospital<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; These activities range from providing adequate and correct information about the disease to all staff and the prioritization of screening tests to the clinical follow-up of all staff who could be positive and all their contacts&#44; in accordance with the recommendations of the Ministry of Health or the administrations of the Spanish &#8216;autonomous communities themselves&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">3</span><p id="par0165" class="elsevierStylePara elsevierViewall">During the pandemic&#44; preoperative screening for active SARS-CoV-2 infection is recommended for all patients who are scheduled to undergo elective surgery<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16&#44;27&#44;28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">4</span><p id="par0170" class="elsevierStylePara elsevierViewall">The choice of tests included in the screening protocol in the form of polymerase chain reaction &#40;PCR&#41;&#44; antigens&#44; imaging tests&#44; etc&#44; will vary depending on the epidemiological alert scenario and following the AEC scale as well as the epidemiology of the region or province&#44; through the cumulative incidence of cases diagnosed with SARS-CoV-2 infection in the last 14 days&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">5</span><p id="par0175" class="elsevierStylePara elsevierViewall">Depending on the epidemiological scenario&#44; all patients will have a PCR test within 72 h of the scheduled date for surgery&#46; The patient will not be allowed in the unit until the result of the PCR is provided&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">6</span><p id="par0180" class="elsevierStylePara elsevierViewall">Each unit must establish the patient circuit for the PCR test and evaluation of the result before surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">7</span><p id="par0185" class="elsevierStylePara elsevierViewall">Like other scientific societies&#44; we recommend that the patient and their companion rigorously maintain distancing measures from the day of the preoperative PCR until the date of their surgery to reduce the risk of infection<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">8</span><p id="par0190" class="elsevierStylePara elsevierViewall">In phase I alert&#44; the epidemiological situation is considered favorable&#44; and practically normal surgical activity can be carried out&#44; maintaining the safety measures agreed upon with preventive medicine&#46; In this situation&#44; and in patients with intermediate risk and surgery&#44; PCR will be omitted<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; In the case of a patient with a positive PCR&#44; as in cases of suspicious symptoms of COVID-19 disease during screening&#44; <span class="elsevierStyleBold"><span class="elsevierStyleItalic">surgery will be suspended and postponed for at least seven weeks&#44; provided that the pathology and the patient&#8217;s status allow</span></span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; The patient will be referred to the primary care doctor&#44; who will establish the appropriate confinement and treatment measures<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">9</span><p id="par0195" class="elsevierStylePara elsevierViewall">Patients with negative PCR may be scheduled for surgery without the requirement of additional preoperative tests<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Preoperative evaluation</span><p id="par0200" class="elsevierStylePara elsevierViewall">The ambulatory surgery consultation can be a second&#44; successive or even the first consultation&#44; in which the patient is added to the surgical waiting list&#44; based on their diagnosis&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Recommendations for the consultation follow&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">1</span><p id="par0210" class="elsevierStylePara elsevierViewall">During the COVID-19 pandemic&#44; &#8220;<span class="elsevierStyleBold"><span class="elsevierStyleItalic">single-visit outpatient surgery consultations are encouraged</span></span>&#8221;&#44; at which time the surgeon will assess the patient&#44; the patient is added to the waiting list&#44; the anesthesiologist and CMA nursing staff evaluate the patient&#44; and preoperative tests are done<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;32</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">2</span><p id="par0215" class="elsevierStylePara elsevierViewall">In order to avoid unnecessary visits to the hospital and for the sake of epidemiological screening&#44; <span class="elsevierStyleBold"><span class="elsevierStyleItalic">a preoperative teleconsultation is used</span></span><a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a> for simple screening and subsequent scheduling of the multiple consultation visit to the hospital in the case of first visits&#44; or as a single teleconsultation in successive ones&#46; Therefore&#44; it is necessary to establish a system of communication with the patient &#40;email&#47;telephone&#47;e-consultation&#41; that guarantees compliance with data protection laws&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">3</span><p id="par0220" class="elsevierStylePara elsevierViewall">In this teleconsultation&#44; through a simple questionnaire &#40;Appendix B&#44; Addendum I&#41; and in the event that one or more of the answers is affirmative&#44; the consultation &#40;or the surgery&#44; if already scheduled&#41; is postponed for a minimum period of seven weeks&#46; The patient is referred to the Primary Care doctor&#44; who will establish the appropriate isolation and follow-up measures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">4</span><p id="par0225" class="elsevierStylePara elsevierViewall">In the in-person consultation&#44; a series of recommendations must be followed by both patients and healthcare professionals &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; to guarantee the safety of all<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">5</span><p id="par0230" class="elsevierStylePara elsevierViewall">The patient&#8217;s medical records should reflect whether the consultation was in-person or not&#46; The interview must be recorded in the medical record&#44; indicating that the patient has been informed of the characteristics of the intervention&#44; the associated risks&#44; the patient&#8217;s acceptance to participate in it and the consent given by the patient&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">6</span><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">It would be highly efficient and useful to have an electronic signed informed consent &#40;IC&#41;</span></span>&#44; since this would avoid the circulation of paper documents through different departments&#44; although organizing the signature of the IC form will depend on each unit according to its characteristics&#46; Many hospitals are including a specific consent form regarding the current COVID pandemic situation as an addendum to the IC&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">7</span><p id="par0240" class="elsevierStylePara elsevierViewall">In the case of patients who have had COVID-19 disease&#44; both the decision of their outpatient surgery and the request for additional preoperative tests will be decided on in an individual manner<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></li></ul></p><p id="par0245" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the sequence for including patients on the ambulatory surgery waiting list&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Major ambulatory surgery unit and operating room</span><p id="par0250" class="elsevierStylePara elsevierViewall">Each unit&#44; depending on its characteristics and resources&#44; must assess the spaces and circuits in order to maintain safe distances in all phases of the process<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The general protection standards of the ambulatory surgery unit are expressed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Patient reception</span><p id="par0260" class="elsevierStylePara elsevierViewall">When the patient arrives at the hospital&#44; it is necessary to confirm that the clinical-epidemiological survey is available in the medical records along with the negative PCR result as well as the verification of the IC&#46; The patient&#8217;s temperature is taken&#44; and an identification bracelet will be placed on his&#47;her wrist&#46; Some scientific societies<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> recommend that the patient&#8217;s accompanying family member also complete the clinical-epidemiological screening survey&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ambulatory surgery unit waiting room</span><p id="par0265" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">1</span><p id="par0270" class="elsevierStylePara elsevierViewall">Both the patient and family member must wear a surgical mask throughout their stay in the hospital&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">2</span><p id="par0275" class="elsevierStylePara elsevierViewall">It is recommended to limit the patient to a single companion&#44; who should wait outside the surgical ward to avoid crowding the area&#46;</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">3</span><p id="par0280" class="elsevierStylePara elsevierViewall">The chairs in the waiting rooms of the day surgery units must be 2 m apart&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">4</span><p id="par0285" class="elsevierStylePara elsevierViewall">Screens are also recommended to inform the patients&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patient preparation</span><p id="par0290" class="elsevierStylePara elsevierViewall">The patient&#8217;s personal belongings should be stored in the locker or other pre-determined space and handled only when they are going to be used in order to leave surfaces uncluttered to allow for frequent cleaning and sanitizing&#46; The patient must inform the healthcare personnel if the&#47;she has experienced any changes or symptoms related to the COVID-19 infection&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Before taking the patient to the operating room&#44; the nursing staff must complete a checklist to verify the following items<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">&#9642;</span><p id="par0300" class="elsevierStylePara elsevierViewall">The patient is correctly identified by the bracelet and is correctly wearing a mask&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">&#9642;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Patient temperature</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">&#9642;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Negative clinical-epidemiological screening</p></li><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">&#9642;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Negative PCR result</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">&#9642;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Signed IC form &#40;procedure and specific COVID-19&#41;</p></li><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">&#9642;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Compliance with preoperative instructions &#40;fasting&#44; etc&#41;</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ambulatory surgery operating room</span><p id="par0330" class="elsevierStylePara elsevierViewall">The operating room should be specific and exclusive for day surgey&#44; and the following general guidelines should be followed&#46;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">1</span><p id="par0335" class="elsevierStylePara elsevierViewall">An attempt will be made to prioritize surgical techniques that do not require anesthetic procedures that manipulate the airway&#44; based on the criteria put forth in the patient selection section<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;30&#44;32</span></a> and for the types of interventions proposed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">2</span><p id="par0340" class="elsevierStylePara elsevierViewall">For surgical or anesthetic procedures that are likely to generate aerosols&#44; it is necessary to use PPE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0215"><span class="elsevierStyleLabel">3</span><p id="par0345" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists a series of <span class="elsevierStyleBold"><span class="elsevierStyleItalic">specific measures</span></span> to be used in the operating room&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Postoperative recovery unit</span><p id="par0350" class="elsevierStylePara elsevierViewall">Recommendations for the post-anesthesia care unit &#40;PACU&#41; are as follows&#58;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0220"><span class="elsevierStyleLabel">1</span><p id="par0355" class="elsevierStylePara elsevierViewall">Patients will continue to wear a mask in the PACU at safe distances from each other&#46;</p></li><li class="elsevierStyleListItem" id="lsti0225"><span class="elsevierStyleLabel">2</span><p id="par0360" class="elsevierStylePara elsevierViewall">As in the operating room&#44; high-flow oxygen administration should be avoided&#46;</p></li><li class="elsevierStyleListItem" id="lsti0230"><span class="elsevierStyleLabel">3</span><p id="par0365" class="elsevierStylePara elsevierViewall">Venturi masks should be avoided&#44; as they diffuse the spread of droplets if the patient coughs and favor the potential aerosolization of the virus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0235"><span class="elsevierStyleLabel">4</span><p id="par0370" class="elsevierStylePara elsevierViewall">The PACU&#44; like the operating room and the phase II unit&#44; should be specific for ambulatory surgery patients&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Phase II recovery unit</span><p id="par0375" class="elsevierStylePara elsevierViewall">Patients must continue to wear masks&#44; and a safety distance must be maintained between patients&#46; It would be preferable if the patient were alone&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Information to relatives</span><p id="par0380" class="elsevierStylePara elsevierViewall">A specific circuit must be defined to inform family members while avoiding crowded waiting rooms&#46; Some hospitals have established a real-time information system using applications for mobile devices by which family members are informed of the beginning&#44; duration and completion of the surgical intervention in real time&#46; In times like these that bring about the opportunity for change&#44; it would be highly desirable for the use of devices like these &#40;as well as the electronic signature of the IC&#41; to become generalized in all hospitals in our country&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">At home</span><p id="par0385" class="elsevierStylePara elsevierViewall">At discharge&#44; the patient&#8217;s family support should be evaluated at discharge&#44; which ideally will also have been considered in the preoperative evaluation&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">Regular follow-up of the patient will be carried out&#44; with special emphasis on social distancing measures and notification of any complication regarding the patient&#8217;s process or the appearance of any symptom related to COVID-19<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;31</span></a>&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> demonstrates the circuit of ambulatory surgery patients&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Training in ambulatory surgery units and SARS-CoV-2</span><p id="par0400" class="elsevierStylePara elsevierViewall">In the same way that training in the prevention of infection has become widespread&#44; we cannot forget that medical residents and undergraduate students must continue to learn and complete their rotations<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; In addition&#44; medical training should include the use of new information technologies to make telemedicine and teleconsultation effective<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;34&#44;35</span></a>&#46; Another valuable tool is the use of social networks like Twitter as a means to discuss and share scientific evidence<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#44; which is increasingly demonstrating the importance of global communication to defeat the virus&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Final considerations</span><p id="par0405" class="elsevierStylePara elsevierViewall">At this point in the pandemic&#44; in which surgery must continue&#44; ambulatory surgery is an example of quality&#44; efficient medical care that should be established as the center of scheduled surgical activity&#44; and care circuits should be redesigned around it&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">The ambulatory surgery unit must be clearly defined as a perfectly separate COVID-free circuit&#44; with a specific team of medical professionals who could be distributed in different work shifts&#46; The safety of patients and staff must be prioritized&#44; and patients and procedures should be selected through the use of guidelines that we have proposed&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">&#8220;Single-visit&#8221; preoperative consultations should be encouraged and telemedicine tools promoted&#44; without forgetting undergraduate&#47;resident training and the great opportunities offered by new and developing communication technologies&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:14 [
        0 => array:3 [
          "identificador" => "xres1679544"
          "titulo" => "Graphical abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "xres1679542"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1490236"
          "titulo" => "Keywords"
        ]
        3 => array:3 [
          "identificador" => "xres1679543"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0015"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1490235"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Management of ambulatory surgery in SARS-CoV-2"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Selection of patients for ambulatory surgery"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Protection of healthcare professionals and outpatients"
        ]
        9 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Preoperative evaluation"
        ]
        10 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Major ambulatory surgery unit and operating room"
          "secciones" => array:8 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Patient reception"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Ambulatory surgery unit waiting room"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Patient preparation"
            ]
            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Ambulatory surgery operating room"
            ]
            4 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Postoperative recovery unit"
            ]
            5 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Phase II recovery unit"
            ]
            6 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Information to relatives"
            ]
            7 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "At home"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Training in ambulatory surgery units and SARS-CoV-2"
        ]
        12 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Final considerations"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-02-09"
    "fechaAceptado" => "2021-04-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1490236"
          "palabras" => array:3 [
            0 => "Ambulatory surgery"
            1 => "COVID-19"
            2 => "Safety"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1490235"
          "palabras" => array:3 [
            0 => "Cirug&#237;a mayor ambulatoria"
            1 => "COVID-19"
            2 => "Seguridad"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and&#47;or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure&#46; Outpatient Surgery can afford more than 85&#37; of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection&#46; In addition&#44; it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating&#44; so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La situaci&#243;n actual de la pandemia por SARS-CoV-2 tiene paralizada la cirug&#237;a no urgente y&#47;o oncol&#243;gica en muchos hospitales de nuestro pa&#237;s con lo que esto conlleva para la salud de los ciudadanos que est&#225;n pendientes de una intervenci&#243;n quir&#250;rgica&#46; La Cirug&#237;a Mayor Ambulatoria puede abarcar en su cartera de servicios mas del 85&#37; de los procedimientos quir&#250;rgicos que se realizan en un servicio de cirug&#237;a y se presenta como una alternativa factible y segura en el momento actual ya que no precisa de camas de ingreso y disminuye claramente el riego de infecci&#243;n&#46; Adem&#225;s&#44; es la herramienta que deber&#237;a de generalizarse para solucionar la acumulaci&#243;n de pacientes en lista de espera que la pandemia esta generando&#44; por lo que parece oportuno que desde la secci&#243;n de Cirug&#237;a Mayor Ambulatoria de la Asociaci&#243;n Espa&#241;ola de Cirujanos se presenten una serie de recomendaciones para la implementaci&#243;n de la misma en estas circunstancias excepcionales que nos toca vivir&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morales-Garc&#237;a D&#44; Docobo-Durantez F&#44; Capit&#225;n Vallvey JM&#44; Suarez-Grau JM&#44; Campo-Cimarras ME&#44; Gonz&#225;lez-Vinagre S&#44; et al&#46; Consenso de la secci&#243;n de cirug&#237;a mayor ambulatoria de la Asociaci&#243;n Espa&#241;ola de Cirujanos sobre el papel de la cirug&#237;a mayor ambulatoria en la pandemia SARS-CoV-2&#46; Cir Esp&#46; 2022&#59;100&#58;115&#8211;124&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Members of the Surgery-AEC-COVID-19 workgroup are listed in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix A</a>&#46;</p>"
        "identificador" => "fn0005"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:2 [
          0 => array:4 [
            "apendice" => "<p id="par0420" class="elsevierStylePara elsevierViewall">Coordinator of the workgroup&#58;</p> <p id="par0425" class="elsevierStylePara elsevierViewall">Salvador Morales Conde&#44; Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla</p> <p id="par0430" class="elsevierStylePara elsevierViewall">Members of the workgroup&#58;</p> <p id="par0435" class="elsevierStylePara elsevierViewall">Est&#237;baliz &#193;lvarez Pe&#241;a&#44; Hospital Universitario La Paz&#44; Madrid</p> <p id="par0440" class="elsevierStylePara elsevierViewall">Mario &#193;lvarez Gallego&#44; Hospital Universitario La Paz&#44; Madrid</p> <p id="par0445" class="elsevierStylePara elsevierViewall">Jos&#233; Manuel Aranda Narv&#225;ez&#44; Hospital regional Universitario&#44; M&#225;laga</p> <p id="par0450" class="elsevierStylePara elsevierViewall">Josep Mar&#237;a Badia&#44; Hospital General de Granollers&#44; Barcelona</p> <p id="par0455" class="elsevierStylePara elsevierViewall">Jos&#233; Mar&#237;a Balibrea&#44; Hospital Clinic&#44; Barcelona</p> <p id="par0460" class="elsevierStylePara elsevierViewall">Sandra Garc&#237;a Botella&#44; Hospital Cl&#237;nico San Carlos&#44; Madrid</p> <p id="par0465" class="elsevierStylePara elsevierViewall">Xavier Guiro&#44; Hospital Parc Taul&#237;&#44; Barcelona</p> <p id="par0470" class="elsevierStylePara elsevierViewall">Eloy Esp&#237;n Basany&#44; Hospital Vall d&#8217;Hebron&#44; Barcelona</p> <p id="par0475" class="elsevierStylePara elsevierViewall">Esteban Mart&#237;n Antona&#44; Hospital Cl&#237;nico San Carlos&#44; Madrid</p> <p id="par0480" class="elsevierStylePara elsevierViewall">Elena Mart&#237;n P&#233;rez&#44; Hospital Universitario de la Princesa&#44; Madrid</p> <p id="par0485" class="elsevierStylePara elsevierViewall">Sagrario Mart&#237;nez Cortijo&#44; Hospital de Talavera de la Reina&#44; Toledo</p> <p id="par0490" class="elsevierStylePara elsevierViewall">Isabel Pascual Miguela&#241;ez&#44; Hospital Universitario La Paz&#44; Madrid</p> <p id="par0495" class="elsevierStylePara elsevierViewall">Lola P&#233;rez D&#237;az&#44; Hospital Gregorio Mara&#241;&#243;n&#44; Madrid</p> <p id="par0500" class="elsevierStylePara elsevierViewall">Jos&#233; Luis Ramos Rodr&#237;guez&#44; Hospital Universitario de Getafe&#44; Madrid</p> <p id="par0505" class="elsevierStylePara elsevierViewall">In&#233;s Rubio P&#233;rez&#44; Hospital Universitario La Paz&#44; Madrid</p> <p id="par0510" class="elsevierStylePara elsevierViewall">Raquel S&#225;nchez Santos&#44; Complejo Hospitalario de Vigo&#44; Vigo</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Surgery-AEC-COVID-19 Workgroup"
            "identificador" => "sec0085"
          ]
          1 => array:4 [
            "apendice" => "<p id="par0520" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix B"
            "titulo" => "Supplementary data"
            "identificador" => "sec0095"
          ]
        ]
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2640
            "Ancho" => 2333
            "Tamanyo" => 228759
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scheduling sequence of patients for ambulatory surgery&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 4167
            "Ancho" => 1577
            "Tamanyo" => 308723
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient flowchart in ambulatory surgery&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Priority 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Priority 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unilateral or bilateral inguinal hernias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laparoscopic cholecystectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Femoral hernias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laparoscopic antireflux surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Umbilical hernias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperparathyroidism surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epigastric hernias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thyroid surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anal fissure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision of thyroglossal cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anal and perianal simple fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision of branchial fistulae or cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorrhoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adrenal surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Condyloma acuminata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laparoscopic splenectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pilonidal sinus &#40;sacrococcygeal cysts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision of lipomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Soft tissue biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venous reservoirs &#40;placement and&#47;or removal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small incisional hernias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varicose veins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Implantation of peritoneal dialysis catheters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rectal polyps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urgent surgery &#40;appendicitis&#44; abscess drainage&#44; etc&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Breast surgery &#40;benign and&#47;or malignant pathology&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2857065.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Classification of General Ambulatory Surgery procedures&#44; listed by priority&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">WHO&#58; World Health Organization&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for staff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-The waiting room should be organized to guarantee a safe distance between people &#40;2&#8201;m&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Insist on the compliance with hand hygiene measures &#40;WHO 5 moments&#41; in each hospital&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Appointments should be scheduled with enough time in between to avoid crowded waiting rooms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Avoid using rings&#44; watches&#44; bracelets&#44; nail polish or artificial nails&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Patients should wear surgical masks that cover the nose and mouth&#46; If another type of mask is worn&#44; or a respirator with an exhalation valve&#44; this will be substituted or covered with a surgical mask&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Avoid or&#44; if possible&#44; delay inspecting wounds until immediately before surgery or treating wounds that entail a risk for splattering or aerosols &#40;for example&#44; when assessing the upper airway &#91;Malampati&#93;&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Ensure that patients clean their hands with an alcohol-based product upon entering the consultation&#46; If he&#47;she is wearing gloves&#44; they should be removed and alcohol-based gel applied immediately&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Use short-sleeved work uniform &#40;scrubs&#41;&#46; Avoid using scrubs from the surgical unit in other areas of the hospital&#46; Use clean scrubs each day and follow the clothing recommendations of the hospital&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Avoid patients being accompanied except under justified circumstances&#44; in which case the same measures will be followed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Use personal protection equipment &#40;PPE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Selectively clean the patient contact surface areas between patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2857064.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Recommendations for patients and staff in the ambulatory surgery consultations&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">General rules for protection in the ambulatory surgery unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Patients&#44; family members and healthcare staff should have access to hydroalcoholic solution dispensers&#44; which should be correctly indicated&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Patients and family members should wear surgical or FFP2 masks&#44; following mandates that are in effect at the given time&#46; Fabric masks will not be allowed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-A safe distance will be established with patients before entering the OR&#44; depending on the architecture of the facilities&#46; The postoperative recovery and phase II recovery units of each hospital should be clearly organized for strict compliance with distancing measures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-All staff of the unit should have PPE&#44; which will be used rationally and depending on the surgical procedure or anesthesia technique to be performed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-In terms of the cleanliness of the installations&#44; routine cleaning and disinfection protocols should be followed&#44; with more frequent disinfection of high-traffic patient and staff areas&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2857066.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">General rules for protection in the ambulatory surgery unit&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">WHO&#58; World Health Organization&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendations for the ambulatory surgery operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Strictly observe the hand hygiene protocol and recommendations in the healthcare area &#40;5 moments of the WHO&#41; at each hospital&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-It is especially important not to use surgery unit scrubsin consultation areas or the hospitalization wards&#44; and <span class="elsevierStyleItalic">vice versa</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Use FFP3&#44; FFP2 or N95 masks &#40;if the mask has an exhalation valve&#44; this should be covered with a surgical mask&#41; and integral eye protection for examinations or procedures that generate aerosols&#46; Use disposable gowns&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Add screen-type protection for maneuvers that could cause splattering&#44; and use disposable gowns&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Limit the number of people in the operating room&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Keep doors closed to maintain positive pressure&#44; and schedule procedures with enough time in between so that any aerosols generated have time to deposit and be cleaned&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Avoid the administration of high-flow oxygen and&#44; if administered&#44; always under a surgical mask&#46; If oxygen is necessary&#44; nasal cannulae are best&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2857063.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the ambulatory surgery operating room&#46;</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 50902
        ]
      ]
      7 => array:5 [
        "identificador" => "upi0010"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc2.docx"
          "ficheroTamanyo" => 62588
        ]
      ]
      8 => array:5 [
        "identificador" => "fig0015"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx1.jpeg"
            "Alto" => 750
            "Ancho" => 1333
            "Tamanyo" => 159316
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de sanidad&#46; Centro de coordinaci&#243;n de Alertas y Emergencias sanitarias&#46; Actualizacio&#769;n n&#46; 301&#46; Enfermedad por el coronavirus &#40;COVID-19&#41;&#46; 29&#46;01&#46;2021 &#40;datos consolidados a las 14&#58;00 horas del 29&#46;01&#46;2021&#41;&#46; Situaci&#243;n en Espa&#241;a&#46; Available from&#58; <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_304_COVID-19.pdf">https&#58;&#47;&#47;www&#46;mscbs&#46;gob&#46;es&#47;profesionales&#47;saludPublica&#47;ccayes&#47;alertasActual&#47;nCov&#47;documentos&#47;Actualizacion&#95;304&#95;COVID-19&#46;pdf</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "M&#46; &#193;lvarez Gallego"
                            1 => "S&#46; Gort&#225;zar de Las Casas"
                            2 => "I&#46; Pascual Miguel&#225;&#241;ez"
                            3 => "I&#46; Rubio-P&#233;rez"
                            4 => "C&#46; Barrag&#225;n Serrano"
                            5 => "E&#46; &#193;lvarez Pe&#241;a"
                            6 => "J&#46; D&#237;az Dom&#237;nguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2020"
                        "volumen" => "98"
                        "paginaInicial" => "320"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32336467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of patients with COVID-19 infection&#46; Recommendations of the Spanish Association of Surgeons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Balibrea"
                            1 => "J&#46;M&#46; Badia"
                            2 => "I&#46; Rubio P&#233;rez"
                            3 => "E&#46;M&#46; Antona"
                            4 => "E&#46; &#193;lvarez-Pe&#241;a"
                            5 => "S&#46; Garc&#237;a-Botella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.03.001"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2020"
                        "volumen" => "98"
                        "paginaInicial" => "251"
                        "paginaFinal" => "259"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Posicionamiento del Grupo de Trabajo &#171;Cirug&#237;a-AEC-COVID&#187; de la Asociaci&#243;n Espa&#241;ola de Cirujanos sobre la plani&#64257;caci&#243;n de la actividad quir&#250;rgica durante la segunda ola de la pandemia por SARS-CoV-2&#58; la cirug&#237;a debe continuar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Balibrea"
                            1 => "S&#46; Morales-Conde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.10.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2021"
                        "volumen" => "99"
                        "paginaInicial" => "77"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33228971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resource requirements for reintroducing elective surgery during the COVID-19 pandemic&#58; modelling study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Fowler"
                            1 => "T&#46;D&#46; Dobbs"
                            2 => "Y&#46;I&#46; Wan"
                            3 => "R&#46; Laloo"
                            4 => "S&#46; Hui"
                            5 => "D&#46; Nepogodiev"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bjs/znaa012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2020"
                        "volumen" => "108"
                        "paginaInicial" => "97"
                        "paginaFinal" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33640927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective cohort study of the impact of covid19 world pandemic on the management of emergency surgical pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Perea Del Pozo"
                            1 => "D&#46; Aparicio-S&#225;nchez"
                            2 => "F&#46; Hinojosa Ram&#237;rez"
                            3 => "F&#46; Pareja Ciur&#243;"
                            4 => "V&#46;D&#46; Mu&#241;oz-Cruzado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.11918"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2020"
                        "volumen" => "107"
                        "paginaInicial" => "e463"
                        "paginaFinal" => "e464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32790177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A dynamic scale for surgical activity &#40;DYSSA&#41; stratification during the COVID-19 pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Morales-Conde"
                            1 => "A&#46; Balla"
                            2 => "M&#46; &#193;lvarez Gallego"
                            3 => "J&#46;M&#46; Aranda-Narv&#225;ez"
                            4 => "J&#46;M&#46; Badia"
                            5 => "J&#46;M&#46; Balibrea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.11870"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2020"
                        "volumen" => "107"
                        "paginaInicial" => "e425"
                        "paginaFinal" => "e426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32735347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for acting in elective and urgent thoracic surgery during SARS-CoV-2 pandemic&#46; Spanish Society of Thoracic Surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Jarabo"
                            1 => "N&#46; Mart&#237;nez"
                            2 => "A&#46; Caba&#241;ero"
                            3 => "S&#46; Call"
                            4 => "J&#46;L&#46; Campo-Ca&#241;averal"
                            5 => "&#193; Cilleruelo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.08.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2020"
                        "volumen" => "98"
                        "paginaInicial" => "574"
                        "paginaFinal" => "581"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33040975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and SARS-CoV-2&#58; considerations on bariatric surgery and recommendations for the start of surgical activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; S&#225;nchez Santos"
                            1 => "A&#46; Garc&#237;a Ruiz de Gordejuela"
                            2 => "I&#46; Breton Lesmes"
                            3 => "A&#46; Lecube Torell&#243;"
                            4 => "V&#46; Moiz&#233; Arcone"
                            5 => "J&#46;J&#46; Arroyo Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.06.005"
                      "Revista" => array:7 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2021"
                        "volumen" => "99"
                        "paginaInicial" => "4"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32921419"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673613624162"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones de actuaci&#243;n en cirug&#237;a oncol&#243;gica hepatobiliopancre&#225;tica durante la pandemia COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Garc&#237;a-Botella"
                            1 => "M&#46;A&#46; G&#243;mez-Bravo"
                            2 => "M&#46; Di Martino"
                            3 => "M&#46; Gastaca"
                            4 => "E&#46; Mart&#237;n-P&#233;rez"
                            5 => "S&#46; S&#225;nchez-Cab&#250;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2020.10.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2020"
                        "volumen" => "99"
                        "paginaInicial" => "174"
                        "paginaFinal" => "182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33341242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection&#58; an international cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "COVIDSurg Collaborative"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(20)31182-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2020"
                        "volumen" => "396"
                        "paginaInicial" => "27"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32479829"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American College of Surgeons Responds to COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;W&#46; Rusch"
                            1 => "S&#46;D&#46; Wexner"
                            2 => "American College of Surgeons COVID-19 Communications Committee"
                            3 => "Board of Regents&#44; and Officers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jamcollsurg.2020.06.020"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "2020"
                        "volumen" => "23"
                        "paginaInicial" => "490"
                        "paginaFinal" => "496"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elective Surgery during the Covid-19 Pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Wu"
                            1 => "C&#46;R&#46; Smith"
                            2 => "B&#46;T&#46; Lembcke"
                            3 => "T&#46;B&#46;D&#46; Ferreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMclde2028735"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2020"
                        "volumen" => "383"
                        "paginaInicial" => "1787"
                        "paginaFinal" => "1790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33113301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "COVID-19&#58; Guidance for Triage of Non-Emergent Surgical Procedures&#46; &#91;Accessed 9 May 2020&#93;&#46; Available from&#58; <a target="_blank" href="https://www.facs.org/covid-19/clinical-guidance/triage">https&#58;&#47;&#47;www&#46;facs&#46;org&#47;covid-19&#47;clinical-guidance&#47;triage</a>&#46;"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Junta directiva de ASECMA&#46; Recomendaciones para la reapertura de las unidades de CMA durante el periodo de transici&#243;n de la pandemia por el COVID-19 &#40;SARS-CoV-2&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Archilla"
                            1 => "M&#46; Zaballos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir May Amb"
                        "fecha" => "2020"
                        "volumen" => "25"
                        "paginaInicial" => "25"
                        "paginaFinal" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Documento t&#233;cnico&#46; Recomendaciones para la programaci&#243;n de cirug&#237;a en condiciones de seguridad durante la pandemia covid-19&#46; Versi&#243;n 14 de diciembre 2020&#46; Available from&#58; <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Cirugia_electiva.pdf">https&#58;&#47;&#47;www&#46;mscbs&#46;gob&#46;es&#47;profesionales&#47;saludPublica&#47;ccayes&#47;alertasActual&#47;nCov&#47;documentos&#47;COVID19&#95;Cirugia&#95;electiva&#46;pdf</a>&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Sanidad y Consumo&#46; Manual Unidad de Cirug&#237;a Mayor Ambulatoria&#46; Est&#225;ndares y recomendaciones&#46; Available from&#58; <a target="_blank" href="https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/guiaCMA.pdf">https&#58;&#47;&#47;www&#46;mscbs&#46;gob&#46;es&#47;organizacion&#47;sns&#47;planCalidadSNS&#47;docs&#47;guiaCMA&#46;pdf</a>&#46;"
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a Mayor Ambulatoria&#46; Eficiencia en la asistencia sanitaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Porrero"
                            1 => "B&#46; Porrero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2015"
                        "editorial" => "Edita Win2win worldwide"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Major ambulatory surgery&#58; where we are and where are we going"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Capit&#225;n Valvey"
                            1 => "S&#46; Gonz&#225;lez Vinagre"
                            2 => "F&#46; Barreiro Morandeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2017.04.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2018"
                        "volumen" => "96"
                        "paginaInicial" => "1"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28683862"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory Surgery and COVID-10 pandemic&#46; Opportunity for chance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Docobo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Anda"
                        "fecha" => "2020"
                        "volumen" => "31"
                        "paginaInicial" => "134"
                        "paginaFinal" => "135"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La ASAC en la pandemia COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Docobo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cir Anda"
                        "fecha" => "2020"
                        "volumen" => "31"
                        "paginaInicial" => "352"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "BOJA 183&#44; lunes 21 de septiembre de 2020&#46; Acuerdo de 15 de septiembre de 2020&#44; del Consejo de Gobierno&#44; por el que toma conocimiento de la actuaci&#243;n del estudio realizado por la Consejer&#237;a de Salud y Familias sobre los recursos asistenciales en cada provincia andaluza ante el escenario de llegar a los 3&#46;000 pacientes ingresados por COVID-19&#46; Available from&#58; <a target="_blank" href="https://www.juntadeandalucia.es/boja/2020/183/BOJA20-183-00013-10403-01_00177739.pdf">https&#58;&#47;&#47;www&#46;juntadeandalucia&#46;es&#47;boja&#47;2020&#47;183&#47;BOJA20-183-00013-10403-01&#95;00177739&#46;pdf</a>&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "BOJA extraordinario n&#46; 73&#44; viernes 30 de octubre de 2020&#46; Orden de 29 de octubre de 2020&#44; por la que se establecen los niveles de alerta sanitaria y se adoptan medidas temporales y excepcionales por raz&#243;n de salud p&#250;blica en Andaluc&#237;a&#44; para la contenci&#243;n de la COVID-19&#46; Available from&#58; <a target="_blank" href="https://www.juntadeandalucia.es/boja/2020/573/BOJA20-573-00032-13086-01_00180355.pdf">https&#58;&#47;&#47;www&#46;juntadeandalucia&#46;es&#47;boja&#47;2020&#47;573&#47;BOJA20-573-00032-13086-01&#95;00180355&#46;pdf</a>&#46;"
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 Guidelines for Triage of Cancer Surgery Patients&#46; ACS website"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "ACS"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "WWW" => array:2 [
                        "link" => "https&#58;&#47;&#47;www&#46;facs&#46;org&#47;covid-19&#47;clinical-guidance&#47;elective-case&#47;cancer-surgery"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Asociaci&#243;n Espa&#241;ola de Cirujanos&#46; Recomendaciones generales en cirug&#237;a oncol&#243;gica&#46; &#91;Accessed 27 April 2020&#93; Available from&#58; <a target="_blank" href="https://www.aecirujanos.es/files/noticias/152/documentos/Pacientes_oncologicos_y_covid19_v2(1).pdf">https&#58;&#47;&#47;www&#46;aecirujanos&#46;es&#47;files&#47;noticias&#47;152&#47;documentos&#47;Pacientes&#95;oncologicos&#95;y&#95;covid19&#95;v2&#40;1&#41;&#46;pdf</a>&#46;"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Estrategia de vacunacio&#769;n frente a COVID-19 en Espa&#241;a&#46; Grupo de Trabajo Te&#769;cnico de Vacunacio&#769;n COVID-19 de la ponencia de programa y registro de vacunaciones&#46; Actualizaci&#243;n 1&#46; 18 de diciembre de 2020&#46; Available from&#58; <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/covid19/docs/COVID-19_Actualizacion1_EstrategiaVacunacion.pdf">https&#58;&#47;&#47;www&#46;mscbs&#46;gob&#46;es&#47;profesionales&#47;saludPublica&#47;prevPromocion&#47;vacunaciones&#47;covid19&#47;docs&#47;COVID-19&#95;Actualizacion1&#95;EstrategiaVacunacion&#46;pdf</a>&#46;"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protecting healthcare personnel from 2019-nCoV infection risks&#58; lessons and suggestions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Zhang"
                            1 => "S&#46; Liu"
                            2 => "M&#46;I&#46; Xiang"
                            3 => "S&#46; Li"
                            4 => "D&#46; Zhao"
                            5 => "C&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11684-020-0765-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Front Med"
                        "fecha" => "2020"
                        "volumen" => "14"
                        "paginaInicial" => "229"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32212058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Precautions for operation room team members during the COVID-19 pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;D&#46; Forrester"
                            1 => "A&#46;K&#46; Nassar"
                            2 => "P&#46;M&#46; Maggio"
                            3 => "M&#46;T&#46; Hawn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jamcollsurg.2020.03.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "2020"
                        "volumen" => "230"
                        "paginaInicial" => "1098"
                        "paginaFinal" => "1101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32247836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19&#58; How can a department of general surgery survive in a pandemic&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Guerci"
                            1 => "A&#46; Maffioli"
                            2 => "A&#46;A&#46; Bondurri"
                            3 => "L&#46; Ferrario"
                            4 => "F&#46; Lazzarin"
                            5 => "P&#46; Danelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2020.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "2020"
                        "volumen" => "167"
                        "paginaInicial" => "909"
                        "paginaFinal" => "911"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32299626"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative COVID-19 defense&#58; an evidence-based approach for optimization of infection control and operating room management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Dexter"
                            1 => "M&#46;C&#46; Parra"
                            2 => "J&#46;R&#46; Brown"
                            3 => "R&#46;W&#46; Loftus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000004829"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2020"
                        "volumen" => "131"
                        "paginaInicial" => "37"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32217947"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Covid-19&#58; patients should self-isolate for two weeks before elective care&#44; trusts are told"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Z&#46; Kmietowicz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.m1991"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2020"
                        "volumen" => "369"
                        "paginaInicial" => "m1991"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32414707"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804916322109"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing of surgery following SARS-CoV-2 infection&#58; an international prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Nepogodiev"
                            1 => "G&#46; Baiocchi"
                            2 => "R&#46; Blanco-Colino"
                            3 => "F&#46; Wuraola"
                            4 => "D&#46; Ghosh"
                            5 => "R&#46; Gujjuri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.15458"
                      "Revista" => array:4 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2021"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19&#58; role of ambulatory surgery facilities in this global pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Rajan"
                            1 => "G&#46;P&#46; Joshi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000004847"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2020"
                        "volumen" => "131"
                        "paginaInicial" => "31"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32243288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ICT applied to day surgery management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Argente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir May Amb"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "83"
                        "paginaFinal" => "87"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of home monitoring via mobile app on the number of in-person visits following ambulatory surgery&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;A&#46;C&#46;P&#46; Armstrong"
                            1 => "M&#46; Brown"
                            2 => "B&#46; Beber"
                            3 => "J&#46;L&#46; Semple"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamasurg.2017.0111"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Surg"
                        "fecha" => "2017"
                        "volumen" => "152"
                        "paginaInicial" => "622"
                        "paginaFinal" => "627"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28329223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#35;Some4Surgery&#58; una plataforma para promover la educaci&#243;n global"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Landaluce"
                            1 => "J&#46; Mayol"
                            2 => "D&#46; Morales"
                            3 => "B&#46; Estraviz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir And"
                        "fecha" => "2020"
                        "volumen" => "31"
                        "paginaInicial" => "32"
                        "paginaFinal" => "37"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735077/0000010000000003/v1_202203130532/S2173507722000291/v1_202203130532/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7418"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Special article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735077/0000010000000003/v1_202203130532/S2173507722000291/v1_202203130532/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507722000291?idApp=UINPBA00004N"
]

Article information

ISSN: 21735077
Original language: English

DOI:10.1016/j.cireng.2022.02.014

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	14	0	14
2024 September	50	9	59
2024 August	44	8	52
2024 July	31	2	33
2024 June	34	2	36
2024 May	34	1	35
2024 April	21	7	28
2024 March	77	7	84
2024 February	53	2	55
2024 January	45	0	45
2023 December	51	3	54
2023 November	59	5	64
2023 October	121	2	123
2023 September	79	3	82
2023 August	45	3	48
2023 July	46	1	47
2023 June	57	3	60
2023 May	30	10	40
2023 April	27	5	32
2023 March	18	11	29
2023 February	5	0	5
2023 January	3	0	3
2022 December	2	0	2
2022 November	4	0	4
2022 October	8	0	8
2022 September	9	0	9
2022 August	4	0	4
2022 July	4	2	6
2022 June	7	4	11
2022 May	13	4	17
2022 April	26	2	28
2022 March	21	4	25

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter