Feldman, Liane S.

Background: Splanchnic venous thrombosis (SVT) is a potentially severe and frequently underdiagnosed complication following splenectomy in patients with hematologic diseases. Despite its clinical importance, no standardized, evidence-based guidelines currently exist to inform perioperative prevention, diagnosis, or treatment in this population. Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines to estimate the incidence and risk factors for SVT after splenectomy in patients with hematologic diseases. Twenty-eight observational studies comprising 5025 patients were included. Risk factor data were analyzed using random-effects models. In parallel, an international Delphi consensus process was performed involving 35 experts (hematologists and surgeons) from 14 countries. Experts were assigned to five domain-specific groups and developed clinical statements on prophylaxis, diagnosis, and management of SVT. Consensus was defined as ≥80% agreement, and recommendations were graded using the GRADE framework. Results: The pooled incidence of SVT after splenectomy was 11.4%, with higher rates in studies using routine imaging (20.7%) and those conducted at single centers (15.1%). Splenic size and weight were significant risk factors, while age, BMI, and platelet count were not. Disease-specific risk was highest in patients with myeloproliferative neoplasms, lymphoma, and thalassemia. The Delphi process generated 25 consensus statements, 14 of which were classified as strong recommendations. Key guidance included perioperative vaccination, individualized thromboprophylaxis with BMI-adjusted low molecular weight heparin, selective Doppler-based screening in high-risk patients, and stepwise anticoagulation regimens based on thrombus burden and clinical evolution. Conclusion: This study presents the first international consensus-based guidelines for managing SVT after splenectomy in patients with hematologic disease. Developed through systematic evidence synthesis and expert consensus, these recommendations provide a practical framework rather than definitive standards of care and support individualized prevention, detection, and treatment strategies in this high-risk population.

Objective: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. Background: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. Methods: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. Results: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. Conclusions: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.