On Friday, March 13, the American College of Surgeons (ACS) recommended that every U.S. hospital, health system and surgeon “minimize, postpone or cancel electively scheduled operations, endoscopies or other invasive procedures.”
Stop Elective Surgeries, for now – American College of Surgeons
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Secondary#orthopedicsurgery#covid19#electivesurgery
The daily trajectory of COVID-19 cases is likely, according to the ACS, to put an enormous strain on U.S. hospitals for beds, respirators and other resources (including staff) and urgent action is required to prepare for the developing flood of COVID-19 cases.
The ACS is asking:
- “Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.”
- “Immediately minimize use of essential items needed to care for patients, including but not limited to, ICU beds, personal protective equipment, terminal cleaning supplies, and ventilators. There are many asymptomatic patients who are, nevertheless, shedding virus and are unwittingly exposing other inpatients, outpatients, and health care providers to the risk of contracting COVID-19.”
These recommendation mirror recent announcements from The Centers for Disease Control as follows:
- Reschedule elective surgeries as necessary.
- Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible.
- Limit visitors to COVID-19 patients.
- Plan for a surge of critically ill patients and identify additional space to care for these patients. Include options for:
- Using alternate and separate spaces in the ER, ICUs, and other patient care areas to manage known or suspected COVID-19 patients.
- Separating known or suspected COVID-19 patients from other patients (“cohorting”).
- Identifying dedicated staff to care for COVID-19 patients.
Effect on Suppliers of Orthopedic Implants and Instruments
The vast majority of hip, knee, shoulder, extremity and spine surgeries are elective—up to a point. These patients are, to a significant degree, disabled and must eventually have their scheduled surgery.
These patients have been on a long journey with their disease. Together with their physician, they have decided that surgery is utterly essential. Intervention, in these cases may be delayed, but cannot be canceled.
Orthopedic product suppliers can expect a dramatic reduction in scheduled surgeries over the next few months, but then an equally dramatic surge in scheduled surgeries as COVID-19 patient admissions drop over the following months.
Bottom line: use the down time to prepare for the rebound.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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