March 25, 2020

ACS, AORN, ASA release joint statement on elective surgery decision making

By: Judy Mathias
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Editor's Note

The American College of Surgeons (ACS), Association of perioperative Registered Nurses (AORN), and the American Society of Anesthesiologists (ASA) on March 24 released a joint statement regarding decision making on elective surgeries.

The statement includes that: "A Surgical Review Committee, composed of surgery, anesthesiology, and nursing personnel is essential to provide defined, transparent, and responsive oversight."


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In conjunction with this statement, the ACS and surgical specialty societies prepared triage criteria, and issued "Elective Case Triage Guidelines for Surgical Care," which recommends that surgeons curtail the performance of elective procedures.

While some cases can be postponed indefinitely, the vast majority are associated with progressive disease, such as cancer, vascular disease, and organ failure, that will continue to progress. Delaying some cases risks having them reappear as more severe emergencies at a time when they will be less easily handled.

Decision making for elective surgery follows a tiered acuity scale:

  • Tier 1a: Low acuity surgery/healthy patient, outpatient surgery, not life threatening illness. Locations: HOPD, ASC, hospital with low/no COVID-9 census. Action: Postpone surgery or perform in ASC.
  • Tier 1b: Low acuity surgery/unhealthy patient. Locations: HOPD, ASC, hospital with low/no COVID-9 census. Action: Postpone surgery or perform in ASC.
  • Tier 2a: Intermediate acuity surgery/healthy patient, not life threatening but potential for future morbidity and mortality, requires in-hospital stay. Locations: HOPD, ASC, hospital with low/no COVID-9 census. Action: Postpone surgery if possible or consider ASC.
  • Tier 2b: Intermediate acuity surgery/unhealthy patient. Locations: HOPD, ASC, hospital with low/no COVID-9 census. Action: Postpone surgery if possible or consider ASC.
  • Tier 3a: High acuity surgery/healthy patient. Location: Hospital. Action: Do not postpone.
  • Tier 3b: High acuity surgery/unhealthy patient. Location: Hospital. Action: Do not postpone.

Although COVID-19 is a clear risk to all, it is but one of many competing risks for patients requiring surgical care, the statement says.

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