As long as hospitals have bed capacity, elective orthopedic surgery can continue during the pandemic, according to a leading orthopedic surgeon.
There are steps orthopedic surgery practices and hospital-based orthopedic surgery programs can take to continue performing procedures during coronavirus outbreaks, a Chicago-based orthopedic surgeon said.
Even though hospitals have the bed capacity for orthopedic surgeons to perform elective surgeries such as joint replacements and spine procedures, there are hurdles to overcome during outbreaks of coronavirus patients. For example, many hospitals and orthopedic practices face financial pressures, and there is an increased need for infection prevention in the operating room.
There are five ways that orthopedic surgery practices and hospital-based orthopedic surgery programs can meet the challenges of the coronavirus outbreak, says Henry Finn, MD, medical director of the Chicago Center for Orthopedics and Robotic-Assisted Surgery, and professor of Orthopedic Surgery at the University of Chicago.
1. Determine the demand for surgery
Based on assumptions, orthopedic surgeons should try to determine the demand for elective surgery, Finn says.
“In our practice, the demand for surgery is now greater than the fear of the coronavirus. People are afraid of this wave of coronavirus and of not being able to have surgery. Many patients have satisfied their deductible and want their procedure to be completed before the end. of the year, ”he says.
Estimating the demand for surgery can be difficult and will vary from practice to practice, Finn says. “We are not seeing a downward trend in surgery, but I have colleagues who have told me that they have a lower demand for surgery in their practice. It is difficult to predict the demand for surgery, but I can say that our firm is experiencing increased demand. “
2. Perform evidence-based surgery
Orthopedic surgeons need to keep abreast of evidence-based surgical guidelines for performing surgery during the coronavirus pandemic, he says. Advice is available from the American College of Surgery’s “COVID-19 and surgery” as well as the American Academy of Orthopedic Surgeons’ “AAOS Guidelines for Elective Surgery During the COVID-19 Pandemic.”
Finn gave several examples of evidence-based orthopedic surgery guidelines during the pandemic:
- Increased awareness of operating room cleaning and infection prevention measures
- Wear personal protective equipment from head to toe
- Patients in elective surgery should be tested within three days of their procedure, and emergency cases should be tested immediately with rapid COVID-19 tests
- When patients are intubated for anesthesia, all operating room staff who are not involved in the procedure should remain outside the room for six to seven minutes after intubation.
3. Speed up patient discharge
To mitigate the risk of patients contracting COVID-19 or spreading the coronavirus, they must be safely released as soon as possible, Finn says. “We found out that COVID-19 was the biggest motivator for early discharge to occur – patients want to be discharged from the hospital. It’s a little shocking that people who may not have could get help at home can now get help at home during the pandemic. “
Rapid discharge must be weighed against safety concerns, he says. “We find that the majority of patients want to be discharged the next day, but if they have significant co-morbidities or if they do not have the appropriate resources and support at home, we do not send them home. as long as these factors cannot be carefully taken care of. “
4. Use of technology
The use of telemedicine and robot-assisted surgery is helpful during the coronavirus pandemic, Finn says.
“Telemedicine is certainly practical, and it decreases the contact between the patient and the doctor, which decreases the risk of exposure to the coronavirus. … Robotic surgery, in which I have been participating for several months, decreases blood loss and postoperative pain. The smaller incisions also help patients get home sooner. “
5. Renegotiate implant contracts
To help address the financial challenges associated with the pandemic and elective orthopedic surgery, hospitals should try to renegotiate supplier contracts for joint implants, he says. “The costs of implants that hospitals pay can be so high that they affect the ability to make a profit. The costs of implants may be higher than the reimbursement the hospital receives from Medicare. This is where the big dollars lie in the cost of hip and knee replacements. “
To renegotiate these contracts, hospitals must stress the need for cost sharing during the pandemic, Finn says. “Hospitals have to say to implant suppliers, who have a very high profit margin, ‘Look, you’re going to have to share the costs if we’re going to keep doing joint replacements.’ “
Related: Coronavirus: Follow 7 General Principles To Delay Elective Surgery
Christopher Cheney is the editor of clinical care at HealthLeaders.