American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Elective Surgery and COVID-19

Are you confused by the term "elective surgery"? During the ongoing COVID-19 pandemic, elective surgery often has been misunderstood to mean an operation that may not really be needed.

Most surgery is essential, but certain cases should be prioritized.1 Elective surgery is essential surgery. Maintaining access to surgery is an essential part of quality patient care, whether the surgery is needed to cure a medical condition, address infirmity, extend life or contribute to patient well-being.

Additionally, keeping health care workers protected with access to proper PPE, in addition to a fully vaccinated health care work force, will help ensure that hospitals can handle surges in COVID-19 patients while maintaining access to surgical care.

Surgery Prioritization

  • Prioritization should be based on whether your procedure is considered emergent (life threatening), urgent, or necessary, but not as time sensitive (for example, some cancer procedures).
  • Your hospital should develop a prioritization strategy based your community and immediate patient needs.
  • A given surgery may not be an emergency, but it is no less essential to you.
  • We recommend that "decisions to adjust surgical services up or down should occur at a local level driven by hospital leaders including surgeons and in consultation with state government leaders. The decisions should be based on local case incidence, ongoing testing of staff and patients, aggressive use of appropriate PPE and physical distancing practices."2

Effect of Surgery and Cancer Screening Delays

  • Your surgery being delayed can lead to more complicated operations and longer recovery times because disease can progress during the delay.
  • We do not yet have data to support the full extent of surgery delays during the pandemic. However, preliminary research suggests a link between consequences and surgery delays.3
  • Delays in cancer screening can lead to more complicated cases for surgeons, progression of disease, and adversely affect your outcome.4

Maintaining Access to Surgical Care

  • If a hospital ICU is full of COVID-19 patients, it means there's no room for other patients that may need ICU care following surgery, for example trauma patients.
  • A hospital filling up to capacity with COVID-19 patients needs adequate nursing and other patient care staff who may be pulled away from operative care. This creates a staff shortage to assist during surgery.
  • COVID-19 vaccines play an important role in ending the pandemic and reducing the burden of caseloads on hospitals. ACS is aligned with other health care professional organizations in calling for a vaccine mandate for all health workers.5 Additionally, ACS launched the "Talk It Up" campaign to provide surgeons with resources to help discuss COVID-19 vaccines with their patients and the importance of becoming vaccinated.6

References

  1. American College of Surgeons. COVID 19: Elective Case Triage Guidelines for Surgical Care. American College of Surgeons website. March 27, 2020. Accessed January 24, 2022. https://www.facs.org/-/media/files/covid19/guidance_for_triage_of_nonemergent_surgical_procedures.ashx
  2. American College of Surgeons. American College of Surgeons Recommendations Concerning Surgery Amid the COVID-19 Pandemic Resurgence. American College of Surgeons website. October 27, 2020. Accessed January 24, 2022. https://www.facs.org/covid-19/clinical-guidance/resurgence-recommendations
  3. Larson DW, Abd El Aziz MA, Mandrekar JN. How Many Lives Will Delay of Colon Cancer Surgery Cost During the COVID-19 Pandemic? An Analysis Based on the US National Cancer Database. Mayo Clin Proc. 2020;95(8):1805-1807. doi:10.1016/j.mayocp.2020.06.006. https://www.mayoclinicproceedings.org/article/S0025-6196(20)30604-2/fulltext
  4. American College of Surgeons. Study reports drop in lung cancer screening, rise in malignancy rates during spring COVID-19 surge. American College of Surgeons website. December 17, 2020. Accessed January 24, 2022. https://www.facs.org/media/press-releases/2020/lung-screening-121720
  5. American College of Surgeons. Major health care professional organizations call for COVID-19 vaccine mandates for all health workers. American College of Surgeons website. July 26, 2021. Accessed January 24, 2022. https://www.facs.org/media/press-releases/2021/covid-vaccine-072621
  6. American College of Surgeons. Talk It Up: Get Vaccinated. American College of Surgeons website. August 3, 2021. Accessed January 24, 2022. https://www.facs.org/covid-19/toolkits/talk-it-up