COVID-19 is still spreading rapidly and continues to overwhelm healthcare systems across the globe. There are significant shortages of both staff and equipment in many of our hospitals, which is leading both patients and hospitals alike to ask, “Do we need to postpone this surgery?”.
In response, the Centers for Medicare & Medicaid Services (CMS) have published a list of recommendations for when to postpone a procedure or surgery and when to push through.
There are some facilities that they’ve strongly encouraged to shut down entirely. For example, they’ve recommended that all dental procedures be postponed. This is because dentistry in particular has one of the highest risks of transmission, and because they use Personal Protective Equipment (aka PPE—think masks and gloves), resources that are vital in the fight against COVID-19.
How Is The List Determined?
The CMS bases these recommendations on three things:
Location – There are multiple facilities that perform procedures and surgeries. These recommendations focus on Hospitals, Hospital Outpatient Departments, and Ambulatory Surgery Centers (facilities that specialize in elective same-day or outpatient surgical procedures).
Transmission Risk – Locations that have treated patients with COVID-19 present a much higher risk for passing the virus on to others.
Acuity – Acuity is a scale used primarily to help hospitals determine what staff they need. It’s a quick way to identify how much care a particular patient might need based on the condition that they’re in. A high-acuity patient is typically very sick or on the cusp of becoming very sick without medical intervention. Low-acuity patients may have a condition or symptoms, but there is no immediate threat.
Based on the three factors above, these are the recommendations outlined by the CMS:
Tier 1: Postpone
If the patient is low acuity, the procedure should be postponed, regardless of location. Examples include carpal tunnel release, endoscopies, cataracts, and colonoscopies.
Tier 2: Consider Postponing
If the patient is intermediate acuity, postponing should be considered based on how likely or how quickly the patient could get worse. And if the location for the procedure has housed a patient with COVID-19 at any point, postponing is the way to go. Examples here include low-risk cancer, non-urgent spine or joint replacement, and elective angioplasty.
Tier 3: Do Not Postpone
If the patient is high-acuity, meaning their life is at risk or they will get much worse very quickly without the procedure, then move forward. Examples in this tier include most cancers, neurosurgery, transplants, trauma, and certain heart surgeries and procedures.
Ultimately, the decision is up to the hospital performing the procedure and is based on what resources are available, the COVID-19 transmission risk, and the urgency of the surgery or procedure itself.
Learn more at www.cms.gov.