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Elective Surgery in the Age of COV19? (March 20,2020)

If you have elective surgery planned for any condition that can wait 30 to 60 days or even 90 days, forget it and reschedule. Now is not the time to have elective surgery. And just to be practical, you should be thinking about waiting 90 to 120 days, as most of us on the front lines think that this maybe a timeframe where this pandemic will have run its course in the United States. However, that may be optimistic.

The majority of large tertiary care medical centers, meaning large regional referral centers including most academic medical centers and Level I Trauma hospitals are limiting the operating room schedule to all but the most urgent cases. Surgical cases that are being performed include cancer surgery, trauma cases, repair of broken bones, conditions like appendicitis and acute gallbladder disease, infections that require surgical drainage and washout and a small number of other conditions that just can’t wait 30-60 days without causing more harm for the patient.

What’s the rationale for delaying surgery? The main issue(s) are to conserve personal protective equipment (PPE) that healthcare providers are going to need to take care of the expected surge in COVID19 patients and to prevent the spread of infection from patients and providers who may have Covid19 but are not yet showing symptoms. There is a nationwide shortage of N95 masks, the type that can filter out tiny viral-laden air droplets that spread the disease and that healthcare workers depend on to keep them safe. PPE also includes gloves, protective gowns and hats, disposal face masks and eye protection and special cleaning supplies. Without the correct equipment, healthcare workers will become ill and the hospital systems will fail. We are learning this difficult lesson from the challenges that have occurred in northern Italy.

Second, and perhaps equally important is to simply stay away from sources of infection. Hospitals are no place for sick people or people at high risk of contracting infectious illnesses! As the number of patients with flu-like symptoms increases, your likelihood of getting contaminated also increases. Given the long incubation time, contacts may have no symptoms but maybe spreading the virus.

Hospitals are also trying to reduce inpatient numbers in anticipation of a spike in cases. The more capacity hospitals have now, they better they can be prepared for a surge in cases. A small number of elective surgical cases will require ICU admission and that will be one less bed available for a COVID19 patient.

We know that older patients, patients with cardiac disease, patients who are immune-com

promised are affected more severely by Covid19. If you are in a high risk group, there is no reason to risk exposure and risk death for the sake of elective surgery.

Prudent hospitals are reducing visitor access to patients, closing cafeterias, cafes and gifts shops and canceling meetings to limit exposure risk. Understand that these actions are to protect the most vulnerable. We are in uncharted waters so be flexible.

On th

e positive side, President Trump is working with the private sector and private manufacturers to ramp up the production of PPE, ventilators and drugs needed to provide supportive care to COVID19-infected patients. In a large and complex yet coordinated effort, COVID19 test kits, anti-viral drugs and vaccines will be available in just a short time. We expect that the availability of PPE will increase rapidly and help us all get back to safe practices.

In closing, please remember that healthcare workers are your relatives, your neighbors and your friends. Their children are home from school, perhaps alone, maybe their spouses have been laid off with a loss of income, they may be working more shifts than usual. Healthcare providers are struggling with the fear of caring for Covid19 patients, worrying about their family members getting ill, concerned like all of us about lack of food supplies, empty store shelves and all the same issues that everyone else worries about.

We all need to pull together and follow the advice of our political leaders. This is a time to be kin

d, thoughtful and patient.

COVID19 resources for Anesthesiologists, interested healthcare providers and patients.


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