Panel issues guidelines for safe resumption of elective orthopedic surgery

Editor's Note

An expert panel from the American Association of Hip and Knee Surgeons on July 15 issued guidelines that include recommendations for when hospitals and surgical centers can resume elective orthopedic procedures.

A set of 30 recommendations are presented in four categories:

• General—includes criteria based on factors, such as local trends in COVID-19 cases and availability of PPE and testing supplies. Patients infected with COVID-19 should not have elective surgery.
• Preoperative—includes added steps in the preadmission process, such as screening for COVID-19 symptoms, wearing masks, practicing social distancing, and limiting family members and visitors in the hospital. Mandatory diagnostic testing is recommended in areas with a high prevalence of COVID-19. There is no evidence to recommend antibody testing.
• Intraoperative—includes recommendations for carrying out surgery, such as addressing OR ventilation systems, necessary PPE, and cleaning the OR between procedures. The guidelines suggest using regional anesthesia, when possible, to avoid aerosolizations that may occur during intubation. Other recommendations include the use of absorbable sutures or skin glue and occlusive dressing to reduce the need for patients’ returning to the office in the early postoperative period.
• Postoperative—includes safeguards in the PACU, such as wearing masks and putting distance between patients. Length of hospital stay should be minimized, and follow-up visits should be done with telehealth, when possible.

The authors emphasize that each hospital should consider their unique situation in terms of COVID-19 prevalence, staffing, PPE, and more when determining how and when to implement the recommendations.