Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic

Abstract

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Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending Only One Night at the Hospital After Elective, Major Therapeutic Procedures

“…Thus, statewide or provincial policies should not create a carve-out policy for elective surgery such as "ophthalmology only." Rather, policies can reasonably be based on the cases with a substantial probability that the patient would have at most an overnight stay [6]. Our results show that our results apply to at least 72.8% of cases.…”

“…For policymakers and hospital administrators, the implication of our study is that when considering the limitation of elective surgical procedures in the face of the current COVID-19 pandemic, the driving force should not be to forbid "elective" cases or only to allow cases for specific specialties. Rather, they should consider the potential risk of patients requiring postoperative admission for more than one night [6]. Such flexibility might require hospitals to change their policies regarding the overnight boarding of patients in the PACU.…”

“…Personal protective equipment is needed to take care of these patients, and if those supplies are in very short supply, it might not be possible to run a full elective surgical schedule [7]. If the perioperative staff pool is depleted either through contracting COVID-19, being under quarantine, or diverted to take care of inpatients, the elective surgical schedule might need to be reduced [6,7]. Finally, if a patient has serious comorbidities or experienced previous complications (e.g., severe postoperative vomiting) likely to result in postoperative hospitalization, he or she may not be a candidate for an elective procedure in the context of census constraints created by the pandemic.…”

“…Broad policies enacted by state or local governments to prohibit all "elective" surgical procedures to ensure sufficient hospital capacity for pandemic patients may be unnecessarily restrictive because they do not consider the lack of impact from many elective cases on the hospital census [4]. For example, there would be no rationale to restrict patients from having elective cataract surgery based solely on concern on the availability of inpatient beds because those patients are rarely admitted to hospitals following their procedure [5,6]. On the other hand, there could be a reason to restrict care based on other factors such as the absence of sufficient quantities of personal protective equipment, lack of availability of timely preoperative reverse transcriptase-polymerase chain reaction testing for SARS-CoV-2, or inadequate numbers of healthy medical personnel [7].…”

“…We selected a threshold of an overnight stay in the hospital for three reasons. First, for patients reliably discharged on the same day of admission (i.e., length of stay = 0 days), considerations related to hospital admission are moot [6]. Second, ambulatory surgery centers represent a distinct class of facilities that are often geographically distant from hospitals where patients can receive care [12].…”