The last JBJS fast-track article cited the need for clearer definitions of “elective” orthopaedic surgery amid the COVID-19 pandemic. As if in response to that, the newest JBJS fast-track article by DePhillipo et al. further explores the moving-target distinction between elective and necessary orthopaedic surgery. The authors also delineate the possible role of ambulatory surgical centers (ASCs) in handling outpatient surgical procedures that were previously scheduled for inpatient facilities.
Absent clear recommendations about which procedures should be considered important enough to be performed in ASCs, DePhillipo et al. offer the following general suggestions:
- Acute and/or disabling injuries to health-care workers, first responders, and members of the military and police and fire departments
- Osseous fractures and/or irreducible joint dislocations
- Wound/joint infections or postoperative wound dehiscence
- Pathologies that could lead to long-term disability and chronic pain if acute surgical management is delayed
The most specific and valuable information in this article is a table that lists, joint-by-joint, acute orthopaedic injuries that the authors deem “surgically necessary” or “elective-urgent procedures,” along with justifications for each. The authors note that the list is far from “a medical directive or standard of care,” but they propose an interesting rationale for fewer restrictions on elective procedures for low-risk individuals: those who are currently restricted from work or unemployed would have the opportunity to have and recover from surgery and be ready to reenter the work force when the time comes.
Finally, the authors offer best-practice guidance for ASCs in the current climate:
- Limit visitors to all but minor patients, the mentally/physically disabled, and elderly patients who require assistance.
- Administer appropriate screening of patients and staff for signs of illness or other risk factors.
- Ensure that all who are present during intubation and extubation have access to appropriate personal protective equipment, including N95 masks.