COVID-19: Guidance for Elective Surgery

As COVID-19 pandemic rages on, healthcare institutions are under increasing strain. Judicious use of resources and personnel is a must to provide optimum service. Hospitals must take into account their location and how it is placed in the COVID-19 curve to determine the services that can be possible at any given time. The evolving situation demands flexibility and adaptability from all quarters.
 
Normal business if COVID-19 is in its initial stages.
When the infection is at the early stage, hospitals will be able to provide all services as usual. COVID-19 cases will be under control and can be handled along with all other treatments in strict isolation. Even under these conditions, it is advisable to use all equipment and resources carefully as a sudden spike may lead to a severe strain.
 
Elective Surgery guidance during COVID-19
Elective surgeries are those that are advised to treat chronic conditions such as joint problems, which do not require immediate treatment. The outcome of these surgeries will not be significantly affected by delaying them. These surgeries may be performed if COVID-19 is not prevalent in the area. If COVID-19 cases are on the upswing then it is better delay the elective surgeries to protect the patients and manage the resources effectively.  
 
Urgent Elective Surgery– If the disease is more prevalent, elective surgeries should be delayed. Certain surgeries are performed for injuries including fractures. They may not be life saving surgeries and may be delayed for a certain time and in that sense can be classified as urgent elective surgeries. These surgeries can be performed, if possible as a day care procedure after COVID-19 screening.
 
Urgent Surgery– The urgent only situation will be reached when the hospital is filled with COVID-19 patients and all available resources are utilized in their treatment. In this scenario, only urgent surgeries, those that are necessary to prevent or limit permanent impairment of function should be the performed. These will include surgeries for fractures, dislocations etc.
 
Emergency surgery– Emergency only situation is when the hospital and the ICU are full and there is a critical shortage of resources. In such situations, only emergency surgeries required to save life or limb must be performed.
 
Depending on region, situation and necessity, hospitals should take a call on performing surgeries, elective or otherwise. Even in localities where there is not much prevalence of COVID-19, screening, sanitization and infection control protocols as per government guidelines must be followed to offer the best service in these tough times.