Philip S Barie1,2, Vanessa P Ho3, Catherine J Hunter4, Elinore J Kaufman5, Mayur Narayan1, Fredric M Pieracci6, Sebastian D Schubl7, Daithi S Heffernan8, Jared M Huston9,10. 1. Departments of Surgery and Weill Cornell Medicine, New York, New York, USA. 2. Medicine, Weill Cornell Medicine, New York, New York, USA. 3. Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. 4. Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA. 5. Department of Surgery, Penn Medicine, Philadelphia, Pennsylvania, USA. 6. Department of Surgery, DenverHealth Medical Center, University of Colorado Anschutz School of Medicine, Denver, Colorado, USA. 7. Department of Surgery, University of California-Irvine, Orange, California, USA. 8. Department of Surgery, Providence Veterans Affairs Medical Center, Alpert Medical School of Brown University, Providence, Rhode Island, USA. 9. Departments of Surgery and Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA. 10. Science Education, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.
Abstract
Background: As the coronavirus disease-2019 (COVID-19) pandemic continues globally, high numbers of new infections are developing nationwide, particularly in the U.S. Midwest and along both the Atlantic and Pacific coasts. The need to accommodate growing numbers of hospitalized patients has led facilities in affected areas to suspend anew or curtail normal hospital activities, including elective surgery, even as earlier-affected areas normalized surgical services. Backlogged surgical cases now number in the tens of millions globally. Facilities will be hard-pressed to address these backlogs, even absent the recrudescence of COVID-19. This document provides guidance for the safe and effective resumption of surgical services as circumstances permit. Methods: Review and synthesis of pertinent international peer-reviewed literature, with integration of expert opinion. Results: The "second-wave" of serious infections is placing the healthcare system under renewed stress. Surgical teams likely will encounter persons harboring the virus, whether symptomatic or not. Continued vigilance and protection of patients and staff remain paramount. Reviewed are the impact of COVID-19 on the surgical workforce, considerations for operating on a COVID-19 patient and the outcomes of such operations, the size and nature of the surgical backlog, and the logistics of resumption, including organizational considerations, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs to reduce morbidity, length of stay, and cost by rational, equitable resource utilization. Conclusions: Resumption of surgical services requires institutional commitment (including teams of surgeons, anesthesiologists, nurses, pharmacists, therapists, dieticians, and administrators). Structured protocols and equitable implementation programs, and iterative audit, planning, and integration will improve outcomes, enhance safety, preserve resources, and reduce cost, all of which will contribute to safe and successful reduction of the surgical backlog.
Background: As the coronavirus disease-2019 (COVID-19) pandemic continues globally, high numbers of new infections are developing nationwide, particularly in the U.S. Midwest and along both the Atlantic and Pacific coasts. The need to accommodate growing numbers of hospitalized patients has led facilities in affected areas to suspend anew or curtail normal hospital activities, including elective surgery, even as earlier-affected areas normalized surgical services. Backlogged surgical cases now number in the tens of millions globally. Facilities will be hard-pressed to address these backlogs, even absent the recrudescence of COVID-19. This document provides guidance for the safe and effective resumption of surgical services as circumstances permit. Methods: Review and synthesis of pertinent international peer-reviewed literature, with integration of expert opinion. Results: The "second-wave" of serious infections is placing the healthcare system under renewed stress. Surgical teams likely will encounter persons harboring the virus, whether symptomatic or not. Continued vigilance and protection of patients and staff remain paramount. Reviewed are the impact of COVID-19 on the surgical workforce, considerations for operating on a COVID-19 patient and the outcomes of such operations, the size and nature of the surgical backlog, and the logistics of resumption, including organizational considerations, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs to reduce morbidity, length of stay, and cost by rational, equitable resource utilization. Conclusions: Resumption of surgical services requires institutional commitment (including teams of surgeons, anesthesiologists, nurses, pharmacists, therapists, dieticians, and administrators). Structured protocols and equitable implementation programs, and iterative audit, planning, and integration will improve outcomes, enhance safety, preserve resources, and reduce cost, all of which will contribute to safe and successful reduction of the surgical backlog.
Entities:
Keywords:
SARS-CoV-2; coronavirus disease-2019 (COVID-19); elective surgery; health disparities; peri-operative testing; resumption of surgical services
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