COVID-19 Resource Center
COVID-19 Resource Center
April 09, 2020
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Few states provided guidelines on cancellation of elective procedures during COVID-19

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During the COVID-19 outbreak, few states have published guidelines regarding the cancellation of elective procedures specific to orthopedic surgery, according to published results.

Researchers identified published state guidelines regarding the cancellation of elective procedures through an internet search with a publication cutoff of March 24, 2020. Researchers collected data on the number of states providing guidance to cancel elective procedures, as well as which states provided specific guidance in determining which procedures should continue being performed and recorded orthopedic-specific recommendations.

Results showed 30 states published guidance regarding the discontinuation of elective procedures. Researchers found a definition of “elective” procedures or specific guidance for determining which procedures should continue to be performed was provided by 16 states. Guidelines that specifically mentioned orthopedic surgery were provided by five states, of which four states explicitly allowed for trauma-related procedures and four states provided guidance against performing arthroplasty, according to results. Researchers noted guidelines that allowed for the continuation of oncological procedures were provided by 10 states.

Results showed 30 states published guidance regarding the discontinuation of elective procedures during COVID-19.
Results showed 30 states published guidance regarding the discontinuation of elective procedures during COVID-19.

Despite the vague guidance on the cancellation of elective procedures that rarely mentioned orthopedic surgery at the state level, the researchers noted states, hospitals and surgeons can consult the CMS tiered approach for surgical services, which includes low (Tier 1), intermediate (Tier 2) and high-acuity (Tier 3) procedures, as well as “a” and “b” designations to indicate healthy and unhealthy patients.

“CMS recommends postponing all Tier-1 operations, to consider postponing Tier-2 operations and to continue performing Tier-3 operations,” the authors wrote.

However, the researchers noted CMS has not provided guidance on what is considered a “highly symptomatic patient.”

“Guidance regarding the continuation of orthopedic procedures during the COVID-19 pandemic has come from a variety of organizations and frequently has been vague, putting the onus of decision-making on individual hospital systems, as well as surgeons,” the authors wrote. “Ultimately, surgeons must weigh the benefits of performing surgery with the potential impact on public health. While patients wait for surgery, surgeons should provide them information regarding alternative methods of managing their pain.” – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.