While the Anesthesia Quality Institute definition of elective surgery is “a surgical, therapeutic or diagnostic procedure that can be performed at any time or date between the surgeon and patient,” this definition doesn’t reflect nuances that exist in scheduling operative procedures at the current time.
When working with surgeons on scheduling cases, consider reviewing the American College of Surgeons (ACS) statement that includes an Elective Surgery Acuity Scale (ESAS) that balances a patient’s need or impact of a surgical procedure with available resources. Many cancer cases are considered time-sensitive. We recommend close collaboration between surgeons, anesthesiologists, and hospital administration to balance individual patient needs with system resource constraints.
3. When restarting surgery, what are some tactics or actions we can take to develop a rational priority for patient backlog?
The ASA, ACS, AHA and AORN in our “Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic” includes strategies for scheduling surgeries and considerations for prioritizing patients. Planning for resuming surgeries should take into account the perspectives of multiple stakeholders, including those from surgery, anesthesia, nursing and facility administration. Please also review the May 7 ASA Town Hall for additional considerations and discussions.
4. What precautions should be placed on an elective surgery patient who was exposed to COVID-19 via a positive family member and/or cohabitant?
The CDC has recommendations for those exposed to a person with symptomatic COVID-19 during period from 48 hours before symptoms onset until that person meets criteria for discontinuing home isolation. These patients should be instructed as follows: 1) Stay home until 14 days after last exposure and maintain social distance (at least 6 feet) from others at all times; 2) Self-monitor for symptoms (check temperature twice a day and watch for fever, cough, or shortness of breath) and follow CDC guidelines if symptoms develop; 3) Avoid contact with people at higher risk for severe illness (unless they live in the same home and had same exposure).
Based on these recommendations, a patient scheduled for elective surgery who has close contact with someone infected with SARS-CoV-2 should have their case deferred for at least 14 days.
5. How long should a patient wait to have elective surgery after they have had a confirmed COVID-19 infection?
If a patient tests positive for SARS-CoV-2 (PDF), elective surgical procedures should be delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19. A patient may be infectious until either: they have CDC recommended test-based strategy (Resolution of fever without the use of fever-reducing medications, improvement in respiratory symptoms, and a negative results from two SARS-CoV-2 tests ≥ 24 hours apart) or via a CDC non-test based strategy (at least 72 hours since resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms and at least 7 days since symptoms first appeared.
Recommendations regarding the definition of sufficient recovery from the physiologic changes from SARS-CoV-2 cannot be made at this time; however, evaluation should include an assessment of the patient’s exercise capacity (metabolic equivalents or METS).
Viewers of this material should review these FAQs with appropriate medical and legal counsel and make their own determinations as to relevance to their particular practice setting and compliance with state and federal laws and regulations. The ASA has used its best efforts to provide accurate information. However, this material is provided only for informational purposes and does not constitute medical or legal advice. This response also should not be construed as representing ASA policy (unless otherwise stated), making clinical recommendations, dictating payment policy, or substituting for the judgment of a physician and consultation with independent legal counsel.