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Preserving Elective Surgeries in the COVID-19 Pandemic and the Future

Educational Objective
To identify the key insights or developments described in this article

“Cancel everything” has trended as a hashtag during the coronavirus disease 2019 (COVID-19) pandemic, and for good reason. The pandemic has touched virtually every aspect of society, substantially altering, and at its onset halting, the very ways nearly every person in the United States works, learns, lives, and maintains health.

The practice of surgery has not been immune, with emergency declarations by many states to suspend elective procedures and office visits in mid-March. While only temporary, this abrupt cessation of surgery has had far-reaching implications that can inform future approaches in the context of both crisis and uncertainty.

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Article Information

Corresponding Author: Julie Ann Freischlag, MD, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC 27157 (jfreisch@wakehealth.edu).

Published Online: October 5, 2020. doi:10.1001/jama.2020.19594

Conflict of Interest Disclosures: None reported.

References
1.
American College of Surgeons. COVID-19: guidance for triage of non-emergent surgical procedures: Elective Surgery Acuity Scale (ESAS). Published March 17, 2020. Accessed September 28, 2020. https://www.facs.org/covid-19/clinical-guidance/triage
2.
DePolo  J . COVID-19 pandemic delayed breast cancer screening in many parts of the United States. Breastcancer.org website. Published July 30, 2020. Accessed September 28, 2020. https://www.breastcancer.org/research-news/covid-19-delayed-screening-in-us
3.
Fu  SJ , George  EL , Maggio  PM , Hawn  M , Nazerali  R .  The consequences of delaying elective surgery: surgical perspective.   Ann Surg. 2020;272(2):e79-e80. doi:10.1097/SLA.0000000000003998PubMedGoogle ScholarCrossref
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Maringe  C , Spicer  J , Morris  M ,  et al.  The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.   Lancet Oncol. 2020;21(8):1023-1034. doi:10.1016/S1470-2045(20)30388-0PubMedGoogle ScholarCrossref
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Hafner  K . Fear of COVID-19 leads other patients to decline critical treatment. New York Times. Published May 25, 2020. Updated May 29, 2020. Accessed September 28, 2020. https://www.nytimes.com/2020/05/25/health/coronavirus-cancer-heart-treatment.html
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American Hospital Association. Hospitals and health systems face unprecedented financial pressures due to COVID-19. Published May 2020. Accessed September 28, 2020. https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due
7.
American Hospital Association. TrendWatch Chartbook 2018, chapter 4: trends in hospital financing. Trends affecting hospitals and health systems, table 4.4: aggregate hospital payment-to-cost ratios for private payers, Medicare, and Medicaid, 1995-2016. Accessed September 28, 2020. https://www.aha.org/guidesreports/2018-05-23-trendwatch-chartbook-2018-chapter-4-trends-hospital-financing
8.
Toney  ME , Becker  RB . Rural and community hospitals—disappearing before our eyes. National Rural Health Association website. Rural Health Voices blog. Published July 31, 2020. Accessed September 28, 2020. https://www.ruralhealthweb.org/blogs/ruralhealthvoices/july-2020/rural-and-community-hospitals-–-disappearing-befor
9.
Kibbe  MR .  Surgery and COVID-19.   JAMA. 2020;324(12):1151-1152. doi:10.1001/jama.2020.15191PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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