Coronavirus: Follow 7 Overarching Principles for Delaying Elective Surgery

Delaying elective surgery during the COVID-19 pandemic increases hospital bed capacity as well as boosts supplies of personal protective gear and ventilators.

The American College of Surgeons (ACS) has released guidelines for triaging elective surgery during the coronavirus disease 2019 (COVID-19) pandemic.

On Feb. 29, the Centers for Disease Control and Prevention issued interim guidance for healthcare facilities that included a recommendation for hospitals to reschedule elective surgery during the pandemic. On March 18, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries should be delayed during the pandemic.

"As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators," the CMS announcement says.

This week, ACS released guidelines for triaging elective surgery during the pandemic that include seven overarching principles:

1. Although some of the triaging guidelines include recommendations based on a low level of COVID-19 infections, coronavirus cases are expected to surge in the next few weeks and surgical teams are advised to prepare for much higher infection rates when triaging elective surgeries now.

2. Based on surgical judgment and resource availability, patients should get appropriate and timely surgical care.

3. Nonoperative management is advised when it is clinically appropriate for patients.

4. Surgical teams should consider waiting for COVID-19 test results for patients who may be infected.

5. With anticipated staffing shortages, emergency surgical procedures at night should be avoided.

6. Aerosol generating procedures such as intubation and electrocautery of blood increase healthcare worker risk for patients who test COVID-19 positive or are suspected of infection. If aerosol generating procedures are unavoidable, surgical staff should wear full personal protective equipment including an N95 mask or powered, air-purifying respirator designed for operating room use.

7. Although there is insufficient data to make a recommendation for open surgery vs. laparoscopy, surgical teams should pick an approach that reduces operating room time and increases safety for patients and healthcare workers.

The ACS guidelines include detailed recommendations for more than a dozen surgical specialties:

• Cancer Surgery
   
• Breast Cancer Surgery
   
• Colorectal Cancer Surgery
   
• Thoracic Cancer Surgery
   
• Emergency General Surgery
   
• Gynecology
   
• Metabolic-Bariatric Surgery
   
• Neurosurgery
   
• Ophthalmology
   
• Orthopaedics
   
• Otolaryngology
   
• Pediatric Surgery
   
• Urology
   
• Vascular Surgery

The ACS guidelines should be used in conjunction with a joint statement on creating a surgical review committee from ACS, the American Society of Anesthesiologists, and the Association of periOperative Registered Nurses, ACS Executive Director David Hoyt, MD, FACS, said this week in a prepared statement.

"These triage guidelines and joint recommendations are being issued as we appear to be entering a new phase of the COVID-19 pandemic with more hospitals facing a potential push beyond their resources to care for critically ill patients," he said.