Elective Orthopaedic Surgery in the Era of COVID-19: Summary of Current Guidelines and Road Map to Resuming and Sustaining Safe Practice.

Abstract

» The COVID-19 pandemic has forced hospitals in the United States to postpone elective orthopaedic surgery, which has financially impacted health-care systems and left patients vulnerable to increased morbidity.» In combination with the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) recommendations, the American Academy of Orthopaedic Surgeons (AAOS) guidelines should be utilized to stratify orthopaedic conditions into 4 tiers in order to properly define which surgeries are elective.» Recommendations released by the American Association of Hip and Knee Surgeons (AAHKS) and the American College of Surgeons (ACS) have encouraged a checklist approach for implementing a safe return to elective orthopaedic surgery, and include both regional and facility-specific recommendations.» When determining patient eligibility and priority for elective orthopaedic surgery, a standardized virtual orthopaedic examination via telemedicine can be used alongside the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) guidelines, which detail a 4-phase strategy that is based on age, comorbidities, type of surgery, and expected length of hospital stay.» To ensure a safe, sustainable return to surgery and sufficient patient safety, hospital administrators should be aware of preoperative, intraoperative, and postoperative considerations according to the current state of knowledge on COVID-19.