Elective, outpatient surgery begin to return — insights for spine surgeons


Elective and outpatient surgeries are beginning to return in some communities, which will allow spine and orthopedic surgeons to resume care for their patients most in need.

On April 16, President Donald Trump released his Opening America plan, which included calling for outpatient elective surgeries to resume under CMS guidelines. Phase two of the plan includes restarting elective surgeries safely.

Detroit-based Henry Ford Health System resumed outpatient surgeries at five hospitals, according to a report from the Detroit Free Press. The hospitals have dedicated operating rooms for the outpatient procedures, which began on April 16. The surgeries will be for patients without the coronavirus that need time-sensitive procedures, including for cancer and heart disease patients.

The operating rooms will include dedicated teams that are tested for COVID-19 to avoid the spread. Patients are also tested and the health system has a sterilization process to keep the space safe. The patients undergoing surgery are also unlikely to need overnight stays or the ICU.

Oklahoma also cleared the path for elective surgeries to begin in April. Medical providers will have the authority to determine which elective surgeries to move forward with and Gov. Kevin Stitt signed a memorandum featuring an "Elective Surgery Acuity Scale" to help. Minor medical procedures and nonemergent dental procedures will also resume May 1 in the state.

A Fargo, N.D.-based pain clinic and surgery center also plans to reopen April 22 on a limited basis. Patients will undergo COVID-19 screenings before entering the facility and take additional precautions while there. The Center for Pain Medicine Clinic and Surgery Center also plans to enhance cleaning procedures and disinfect surfaces several times per day.

Spine and orthopedic surgeons across the country are reviewing their patients to understand how postponing procedures will affect the patients' long term functionality when deciding how to ramp their practices back up. Additional key considerations include the patient's insurance status — many people may have lost coverage due to sudden unemployment in the past month — and others may need a new preauthorization. Surgeons also need to make sure patients will be safe to return home after surgery and have access to virtual physical therapy after surgery.

Ratnesh N. Mehra, DO, outlined how he was able to perform the first neurosurgical procedure on a known COVID-19 positive patient in Detroit in late March, detailing his precautions and sterilization protocols. The patient required necessary spine surgery, despite the COVID-19 diagnosis.


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