Coronavirus Disease 2019 State Guidelines on Elective Surgery

Considerations for Plastic and Reconstructive Surgeons

Benjamin A. Sarac, BS; Anna R. Schoenbrunner, MD, MAS; Stelios C. Wilson, MD; Ernest S. Chiu, MD; Jeffrey E. Janis, MD


Plast Reconstr Surg Glob Open. 2020;8(5):e2904 

In This Article

Abstract and Introduction


Background: Vague recommendations regarding elective surgery have been proposed by national organizations in an attempt to conserve personal protective equipment and to protect healthcare workers during the coronavirus disease 2019 pandemic. In response, some states have attempted to provide more clear guidance.

Methods: An internet search was performed to identify and analyze what guidance each state published through government websites through April 10, 2020.

Results: Thirty-five states and the District of Columbia published guidance in the form of either a recommendation or a mandate. Procedures relating to cosmetics and malignancy were found to be mentioned in 4 and 12 states, respectively, but ultimately lacked case-specific information.

Conclusions: Current government and state recommendations do not provide clear guidance on how plastic and reconstructive surgeons should approach elective surgeries. Ultimately, it is the responsibility of all plastic and reconstructive surgeons to operate under appropriate law while individualizing their practices to best suit the needs of their patients while being mindful of resource limitations and exposure risks.


The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has influenced national and local healthcare policy and has abruptly changed medical practices around the world. The United States has lacked clear guidance from national societies on how surgical and procedure-oriented professions should temporarily alter their practices. On March 13 and 15, 2020, the American College of Surgeons[1] and Centers for Medicare and Medicaid Services (CMS),[2] respectively, released recommendations on how to approach elective/nonurgent surgery. Recommendations, however, are not guidelines and, thus, neither mandatory, nor enforceable. In light of CMS guidelines and an overall effort to decrease unnecessary utilization of personal protective equipment (PPE), many states have published more official guidance on how to address elective surgeries and procedures during the pandemic. The effect this will have on plastic and reconstructive surgery as a specialty will be variable and unpredictable. The authors seek to communicate the landscape of the most current guidance published by each state and provide discussion on the impacts to the field of plastic and reconstructive surgery.