Roadmap for Restarting Elective Surgery During/After COVID-19 Pandemic

Sharma, Dhananjaya; Agrawal, Vikesh; Agarwal, Pawan

doi:10.1007/s12262-020-02468-5

Cited by 13 publications

(9 citation statements)

References 37 publications

(5 reference statements)

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“…Professional bodies and societies around the world have weighed in this issue by releasing guidelines and principles for the safe resumption of elective surgical services [2] , [3] , [4] , [5] . Most notably, the American College of Surgeons, American Society of Anesthesiologists, Association of Peri-Operative Registered Nurses, and American Hospital Association have jointly issued a suggested roadmap that delineates four main categories of issues that should be addressed in such planning [5] .…”

Section: Background and Significancementioning

confidence: 99%

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms

Abdullah

Lam

Ang

et al. 2022

International Journal of Medical Informatics

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Objective To develop a 2-stage discrete events simulation (DES) based framework for the evaluation of elective surgery cancellation strategies and resumption scenarios across multiple operational outcomes. Materials and Methods Study data was derived from the data warehouse and domain knowledge on the operational process of the largest tertiary hospital in Singapore. 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 were extracted for the study. A clustering approach was used in stage 1 of the modelling framework to develop the groups of surgeries that followed distinctive postponement patterns. These clusters were then used as inputs for stage 2 where the DES model was used to evaluate alternative phased resumption strategies considering the outcomes of OR utilization, waiting times to surgeries and the time to clear the backlogs. Results The tool enabled us to understand the elective postponement patterns during the COVID-19 partial lockdown period, and evaluate the best phased resumption strategy. Differences in the performance measures were evaluated based on 95% confidence intervals. The results indicate that two of the gradual phased resumption strategies provided lower peak OR and bed utilizations but required a longer time to return to BAU levels. Minimum peak bed demands could also be reduced by approximately 14 beds daily with the gradual resumption strategy, whilst the maximum peak bed demands by approximately 8.2 beds. Peak OR utilization could be reduced to 92% for gradual resumption as compared to a minimum peak of 94.2% with the full resumption strategy. Conclusions The 2-stage modelling framework coupled with a user-friendly visualization interface were key enablers for understanding the elective surgery postponement patterns during a partial lockdown phase. The DES model enabled the identification and evaluation of optimal phased resumption policies across multiple important operational outcome measures. Lay abstract During the height of the COVID-19 pandemic, most healthcare systems suspended their non-urgent elective surgery services. This strategy was undertaken as a means to expand surge capacity, through the preservation of structural resources (such as operating theaters, ICU beds, and ventilators), consumables (such as personal protective equipment and medications), and critical healthcare manpower. As a result, some patients had less-essential surgeries postponed due to the pandemic. As the first wave of the pandemic waned, there was an urgent need to quickly develop optimal strategies for the resumption of these surgeries. We developed a 2-stage discrete events simulation (DES) framework based on 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 captured in the Singapore General Hospital (SGH) enterprise data ware...

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Section: Background and Significancementioning

confidence: 99%

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms

Abdullah

Lam

Ang

et al. 2022

International Journal of Medical Informatics

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“…tested positive for COVID-19 (e.g., Spain 36 and Italy 37 ), with many advising that surgery should be postponed until the patient has been asymptomatic for 72 hours and has received a least 2 negative COVID-19 tests, 24 hours apart. 38 Testing for COVID-19 pre-surgery is also recommended, as an asymptotic patient undergoing surgery is at risk of increased complications and mortality. 39…”

Section: Prioritization Of Surgeriesmentioning

confidence: 99%

Backlog to Surgery due to COVID-19 and Considerations to Address to Catch-up Safely

Lewis¹

2020

JoARMST

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On March 11th 2020, COVID-19 met all criteria to be considered a pandemic. The resulting halt in surgery led to an estimated 28.4 million elective surgery cancellations around the globe. Figures suggest that the backlog to surgery may take years to clear, causing huge detrimental effects to both the economy and the health of patients. Addressing this surgical backlog, whilst ensuring the health and safety of healthcare professionals and patients during surgery, will require a multifaceted approach. Key aspects, such as providing a sufficient and stable supply of Personal Protective Equipment (PPE), adequate and efficient testing of healthcare staff and patients, and availability of post-acute care, need to be secured before surgery can recommence safely in this COVID-19 era.

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“…Dulcē et decorum est prō patriā morī" (it is sweet and befitting to die for the homeland) has become the most appropriate description for the sacrifice of healthcare professionals. [2] Heeding to these developments, all elective orthopedic surgeries were cancelled and postponed at our tertiary care referral center. [3] Only cases considered emergency, or those which would lead to significant morbidity if delayed, were considered for admission and surgery.…”

Section: Introductionmentioning

confidence: 99%

Has the time to reinstate elective orthopedic procedures come?

Vatsya

Mittal

Trikha

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Roadmap for Restarting Elective Surgery During/After COVID-19 Pandemic

Cited by 13 publications

References 37 publications

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms

Backlog to Surgery due to COVID-19 and Considerations to Address to Catch-up Safely

Has the time to reinstate elective orthopedic procedures come?

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