Opinion

Critical Nonemergency Surgeries Can and Should Continue Safely

Despite the continued spread of COVID-19, we are beginning to see light at the end of the tunnel. Gratefully, vaccines are being administered and we continue to learn more every day about how to treat critically ill coronavirus patients.

Together, our organizations represent the interests of more than 5,900 ambulatory surgery centers and the 54,000 physician anesthesiologists who provide care in them. The medical professionals we represent perform more than 20 million surgeries and medical procedures each year, and virtually all of the care we provide is deemed “nonessential” or “elective” in medical parlance.

Importantly, nonessential and elective does not mean unnecessary or unimportant. It simply means nonemergent, or that the patient’s life is not in danger if the required care is not delivered immediately. These surgeries and procedures, however, remain essential to eliminating disease, chronic pain, disabling impairments and other afflictions that can, over time, become life threatening.

For instance, removing cancerous tumors, clearing blocked arteries and repairing or replacing diseased joints that disable patients are all, technically, not considered emergency surgery. But they are essential to the well-being of the patients who need them. Needlessly delaying essential surgeries can do significant harm to millions of patients. Tumors can grow. Arteries become more blocked. And diseased joints become more painful and debilitating.

When many public health officials across the country called for the suspension of all nonessential surgeries at the onset of the pandemic, their rationale was twofold. On one hand, they expressed concern that hospitals on the front lines of treating COVID-19 patients could run out of personal protective equipment, and that we needed to preserve the PPE supplies outpatient health care providers already possessed. On the other hand, there was a presumption that nonessential surgeries could accelerate the spread of the COVID-19 virus to vulnerable patients. Ultimately, neither assumption proved accurate.

With respect to the PPE issue, we have seen higher demand for products in the marketplace and a spike in prices, but an accompanying surge in manufacturing has continued to meet the demands of both hospitals and ASCs.

With respect to the assumption that nonessential surgeries would hasten the spread of the COVID-19 virus, the data and evidence tells a different story: Health care settings have continued to excel at infection prevention, despite the pandemic.

For example, prior to the arrival of the COVID-19 virus, ASCs, hospital outpatient departments and inpatient hospitals operated under a rigorous set of professional standards and public health regulations designed to prevent the spread of any type of infection. Since March 2020, they have also been operating under additional protocols, including mandatory face coverings for both patients and staff, additional cleaning and air circulation procedures and, in many cases, the elimination of waiting rooms for family members and friends.

One survey conducted by the Ambulatory Surgery Center Quality Collaboration, an organization established to develop quality measures for surgery centers, asked more than 700 surgery centers to report the occurrence of post-operative COVID-19 infections. Specifically, 709 outpatient surgery centers in eight states were surveyed about essential care provided during March and April in 2020. A total of 84,446 patient procedures were included in the survey. Only 16 of those patients tested positive for COVID-19 within 14 days after their procedure, an infinitesimally small infection rate of just .02 percent. It should also be noted that there is no way of actually knowing when or how the 16 patients became infected.

Regrettably, all indications are that the COVID-19 virus will inflict a lot more suffering in 2021 before we can vaccinate enough people to halt the spread of this deadly disease. What we do now know is that we should not further compound our public health challenges by erroneously and unnecessarily suspending vital and essential elective surgeries and procedures.

 

Bill Prentice is the CEO of the Ambulatory Surgery Center Association. Paul Pomerantz is the CEO of the American Society of Anesthesiologists. 

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