The American College of Surgeons released recommendations for management of elective surgical procedures and essential resources following a careful review of the current situation surrounding COVID-19.

Until the predicted inflection point in the exposure graph has been passed and a potentially rapid and overwhelming uptick in critical patient care needs can be supported by the health care infrastructure, the ACS recommends all hospitals, health systems and surgeons “thoughtfully review all scheduled elective procedures with a plan to minimize, postpone or cancel electively scheduled operations, endoscopies or other invasive procedures,” according to the release. The ACS also recommends immediately minimizing use of essential items needed to care for patients, such as ICU beds, personal protective equipment, terminal cleaning supplies and ventilators.

Surgeons who practice in an area that is not a geographic COVID-19 “hot zone” should refer to the CDC website for guidance, the ACS noted. For inpatient facilities, the ACS noted the CDC recommends the following:

– rescheduling elective surgeries as necessary;

– shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings when feasible;

– limit visitors to COVID-19 patients; and

– plan for a surge of critically ill patients and identify additional space to care for these patients.

The ACS noted hospitals and practices should also familiarize themselves with infection control practices in the event a patient presents with symptoms, including donning N95 respirator masks; donning full personal protective equipment, including protective eyewear; doffing personal protective equipment responsibly; and decontaminating hands with EtOH-based gel after doffing equipment.


Current estimates by the CDC predict that millions of people could be infected with COVID-19 in the upcoming months. The widespread transmission could potentially translate into large numbers of people requiring simultaneous hospitalization and intensive medical care, which could overburden the system and deplete resources. COVID-19 has sparked policy changes throughout hospitals and health care systems in the United States. These policies were created in an attempt to free

health care resources and allow for safe and effective treatment of patients.

The American College of Surgeons should be commended for providing guidance during these difficult times. These policies are not without consequence to orthopedic surgeons, particularly since many surgeons’ practices are predicated on elective cases. As public health policies such as ‘social distancing’ are being implemented and many businesses are being closed to prevent viral spread, surgeons must be mindful that patients and physicians alike are at risk for disease exposure whenever they are in contact. It is important to remember that this small, transient sacrifice is for the greater good, and to uphold the principles of the Hippocratic Oath.

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