Restarting Essential Surgery in the Era of COVID-19

A Cautious Data Driven Approach Based on the Literature and Local Data

Adam C. Fields, MD; Joshua C. Vacanti, MD; Chanu Rhee, MD, MPH; Michael Klompas, MD, MPH; Sanjat Kanjilal, MD, MPH; Luisa Maldonado, BS; Malcolm K. Robinson, MD; Louis L. Nguyen, MD, MBA, MPH; Marc Philip T. Pimentel, MD, MPH; Gerard M. Doherty, MD; Ronald Bleday, MD


Annals of Surgery. 2020;272(3):e208-e210. 

In This Article

Abstract and Introduction


On March 11, 2020 the World Health Organization declared the coronavirus (COVID-19) outbreak a global pandemic.[1] In efforts to increase bed capacity, conserve vital medical resources, safeguard our patients, and protect frontline healthcare workers (HCWs), elective surgery across the United States came to a halt. Several states have mandated operating room (OR) closures for nonessential elective invasive procedures.[2,3] Although we have not completely passed the first wave of the virus, and there is uncertainty of how long the pandemic will last, we are now being tasked with reopening our ORs for cases that were deferred. Less urgent elective cases will need to resume too at some point because elective surgery does not mean nonessential surgery. We believe it is reasonable to start asking: how can we do this in a safe and coordinated fashion?

Even if the daily count of new COVID-19 cases continues to decline, there will still be a constant concern that any surgical patient may be harboring severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19. This is based on studies showing that some patients with COVID-19 have mild or no symptoms, and yet may be contagious or at risk for perioperative illness. As we reintroduce elective surgery, we need a new set of safety practices for providers and patients. In addition, patient selection during this period will be critical. Limited data from China have shown that outcomes of occult COVID-19 positive patients who undergo surgery are poor; 44% of patients required intensive care unit (ICU) admission and 25% died.[4] Patient selection must also consider the potential burden on hospital resources.

In this article, we will discuss how we plan to restart elective surgery in our hospital. We will review local data and published literature as the basis for our recommendations. Although these recommendations may not apply to all institutions, our goal is to inform potential strategies that other hospital systems similarly restarting elective surgery may wish to consider.