Guidelines for Resuming Elective Orthopaedic Surgery

OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Adam Bitterman, DO in response to 2 recent articles in the July 15, 2020 issue of The Journal of Bone & Joint Surgery.

The United States continues to struggle in the grip of the global COVID-19 pandemic. Certain regions within the US are experiencing a sharply increased COVID-19 case volume, while other locales have stabilized their disease burden. But overall, the country’s healthcare system and economy remain under stress.

Healthcare systems in regions that don’t have high COVID-19 burdens have begun to provide their full list of services, of which elective orthopaedic surgery is one. However, amid concern about a “second wave” of the pandemic, the reemergence of elective orthopedic surgery must be made–and monitored–in the context of public health. Now more than ever, surgeons and their patients must consider how individual patient-centered decisions might play out in the public domain.

As Anoushiravani and colleagues point out, the return of elective orthopedic surgery should be based in large part on the COVID-19 burden in any given geographic location. Local jurisdictions must regulate the return to “normalcy” according to measurements that gauge activity of the virus, such as the number of new diagnoses and hospitalizations and the percent occupancy of ICU beds. In another JBJS article on this topic, Parvizi et al. emphasize that local hospitals and health systems need to weigh resumption of elective orthopaedic procedures also against staffing capability and available supplies of PPE and ventilators. The sensible recommendations from both sets of authors emphasize the importance of ascertaining local disease patterns in order to provide appropriate and safe care for all patients.

The new “normal” in healthcare is a moving target that requires fluidity and flexibility to make frequent reassessments. The economic disruption caused by the pandemic may take years to resolve, and economics is another factor in these resuming-surgery equations. As members of the healthcare team, it is imperative that we focus on the well-being of our patients, surgical team and staff, and our local community. We all must be vigilant for signs of resurgence of the disease. And, please, wear a mask whenever you are out in public and social distancing is not feasible.

Adam Bitterman, DO is a foot and ankle specialist, an assistant professor of orthopaedic surgery at Zucker School of Medicine at Hofstra/Northwell, and a member of the JBJS Social Media Advisory Board.

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