COVID-19 and Elective Surgery

On March 27, 2020, Governor Phil Murphy signed Executive Order 109 requiring all non-essential adult elective surgeries and procedures suspended until further notice. What are elective surgeries? Why were they suspended? And when will they be permitted?

What are elective surgeries?

Elective surgeries as defined by NJ Executive Order 109 are procedures that can be delayed without undue risk to the current or future health of the patient as determined by your physician or dentist.  Family planning and vaccines are protected procedures.  Hospitals and ambulatory surgery centers are required to make written guidelines on determining whether a procedure is elective or urgent.

Why is my surgery suspended?

Elective surgery draws on numerous resources.   Anesthesiologists, nurses, CRNAs, surgeons are all required for safe surgery and to fight COVID-19.  Equipment such as masks, gloves, gowns, and ventilators are utilized by elective procedures.  With every surgery, there is also a risk of complications that may require admission to the hospital.  In addition, there is also increased risk of spreading the disease to patients and staff since surgery is typically done in close quarters.  All these elements take away from the resources that could be used to control the coronavirus pandemic.  

• Personnel 
• Equipment (PPE, ventilators, instruments)
• Admissions
• Post-operative complications
• Spread of COVID-19

Will I wait or proceed with surgery?

Certain procedures such as heart, transplant, or cancer surgery carry significant risk of complications if surgery is delayed.  These procedures can and should be performed urgently. 

Other procedures including cosmetic surgery are not urgent and can be scheduled without significant harm to the patient.  

For all other procedures such as a dental surgery, shoulder arthroscopy, carpal tunnel surgery, and fracture surgery the lines of what is elective and what is urgent is nuanced.  A procedure that is elective now can be urgent weeks from now.  For instance, a fall can result in a minor wrist sprain that can be treated with bracing.   Alternatively, a fall can cause a fracture which may need surgery in the near future.  Your doctor can determine if delaying a procedure can cause undue harm or if the condition can be treated effectively with non-operative methods.  

Your doctor will have to consider the following when determining if a procedure is elective

• Emergent versus not-emergent surgery
• Undue risk of delaying surgery either now or in the future
• Risk of post-operative complications
• Requirement for inpatient admission
• The overall health of the patient
• Local supply of personnel, equipment, and PPE
• Covid-19 cases in the community

Should I see a doctor?

Yes, you should see your doctor immediately.  Many surgical practices including Alta Orthopedics offer telemedicine or virtual visits to reduce the risk of spread.  Only your doctor can determine if your condition can be safely delayed.  Despite the restrictions on elective surgery, delay of your procedure should be balanced by the risk of complications. Also, your doctor will be the first to know when the restrictions will ease.  

When will the restrictions be lifted?

It is hard to know when states will begin to allow elective surgery.  However, it is likely that the both the supply of tests, personnel, equipment, and PPE must be in place prior to allowing elective surgery to resume.   In other states including New York, the restrictions have been lifted beginning in counties that have fewer reported cases of COVID-19.  

NJ COVID-19 Cases per County

Disclaimer:  The content of this blog represents educational material and not medical advice.  Please see your doctor if you require medical attention.  

Author

Amish A. Naik, MD, PhD Amish Naik MD PhD specializes in Orthopedic Surgery with additional training in Hand and Upper Extremity Surgery.