AAOS Guiding Principles for Resuming Surgeries

As elective surgeries resume, orthopedic surgeons will have critical questions to ask and answer before going back into the operating room.

The American Academy of Orthopaedic Surgeons (AAOS) recently issued a document titled: Navigating the COVID-19 Pandemic, to help surgeons answer critical questions for their patients, staff and themselves.

C. Lowry Barnes, M.D., of the University of Arkansas Medical School Department of Orthopaedics, told us, “It is so important that we protect our patients and co-workers. Our patients are depending on their surgeons to tell them when it is safe to have elective surgery. Although they may hear this from the President or their Governor, health care is local and very personal.”

“We should all be working with our hospitals to make sure that we are abiding by established guidelines and opt on the side of caution and in the patient’s best interest. It is important that each surgeon is familiar with state directives regarding elective surgery, the local availability of testing, disease prevalence, as well as his or her hospital’s COVID burden,” added Barnes.

The AAOS guidance document says there’s a lot unknown about COVID-19, so it’s important for surgeons to follow Centers for Disease Control and Prevention (CDC) and relevant federal, state and local public health guidelines.

Five Guiding Principles

Here are the five Guiding Principles from the Academy:

1. First Priority: The safety of patients is and must be of the highest priority when considering the provision of health care services, items and procedures during the COVID-19 pandemic.
2. Second Priority: The safety of health care personnel and staff should be of next highest priority, after accounting for patient safety, when considering the provision of health care services, items and procedures.
3. Adhere to Centers for Disease Control Prevention (CDC), and relevant federal, state and local public health guidance and recommendations; the safety of our patients and staff members is paramount.
4. Decisions should be locally based, as factors vary by locale; this includes incidence, prevalence, patient and staff risk factors, community needs, and resource availability (to include intensive care unit (ICU) beds, hospital beds, ventilators, and personal protective equipment (PPE)). It is imperative to accurately determine if the disease burden curve trajectory in your local community is increasing, flattening, or decreasing, as well as the reproductive number; greater than, equal to, or less than one.
5. Follow legal restrictions: many states and locales have mandated shutdowns and stay-at-home orders; it is important to adhere to these legal requirements.

The Academy also offers other important considerations. For instance:

• Has your area seen a sustained reduction (i.e. more than or equal to 14 days) in new cases of COVID-19?
• Are all patients in your area with COVID-19 symptoms able to access testing?
• Is your state able to conduct active monitoring of confirmed or suspected cases and their contacts?
• Are you able to verify if your patients have undergone testing?
• Should different criteria apply to patients with higher risk of severe consequences from a COVID-19 infection, specifically those over 65 or with significant comorbidities?

Testing, Telehealth and More

Finally, the guidance document covers areas of testing for the virus, risk stratification, telehealth services, in-person services and elective surgery and other considerations relating to ambulatory surgical centers and velocity of return of certain cases.