As long as hospitals have bed capacity, elective orthopedic surgery can continue during the pandemic, a prominent orthopedic surgeon says.
There are steps orthopedic surgery practices and hospital-based orthopedic surgery programs can take to continue performing procedures during coronavirus surges, a Chicago-based orthopedic surgeon says.
Even if hospitals have the bed capacity for orthopedic surgeons to perform elective surgeries such as joint replacements and spine procedures, there are barriers to overcome during coronavirus patient surges. For example, many hospitals and orthopedic practices face financial pressures, and there is a heightened need to achieve infection prevention in the operating room setting.
There are five ways orthopedic surgery practices and hospital-based orthopedic surgery programs can rise to coronavirus surge challenges, says Henry Finn, MD, medical director of the Chicago Center for Orthopedics and Robotic-Assisted Surgery, and a professor of orthopedic surgery at the University of Chicago.
1. Determine surgery demand
Based on assumptions, orthopedic surgeons should try to determine the demand for elective surgery, Finn says.
"In our practice, the demand for surgery now is greater than the fear of the coronavirus. People are fearful of this coronavirus surge and not being able to get surgery. Many patients have satisfied their deductible and want to get their procedure done before the end of the year," he says.
Estimating demand for surgery can be challenging and will vary from practice to practice, Finn says. "We are not seeing a down trend in surgery, but I do have colleagues who have told me they have lower demand for surgery in their practices. It is challenging to predict demand for surgery, but I can say our practice is experiencing increased demand."
2. Practice evidence-based surgery
Orthopedic surgeons should stay current on evidence-based surgery guidelines for performing surgery during the coronavirus pandemic, he says. Guidance is available in the American College of Surgery's "COVID-19 and Surgery" as well as the American Academy of Orthopaedic Surgeons' "AAOS Guidelines for Elective Surgery During the COVID-19 Pandemic."
Finn gave several examples of evidence-based orthopedic surgery guidelines during the pandemic:
- Heightened awareness of OR cleaning and infection prevention measures
- Wearing head-to-toe personal protective equipment
- Elective surgery patients should be tested within three days of having their procedure, and emergency cases should be tested immediately with rapid COVID-19 tests
- When patients are intubated for anesthesia, all OR staff members who are not involved in the procedure should stay out of the room for six to seven minutes after intubation
3. Expedite patient discharge
To mitigate the risk of patients contracting COVID-19 or spreading the coronavirus, they should be discharged as soon as safely possible, Finn says. "We have found that COVID-19 has been the greatest motivator for early discharge to occur—patients want to get out of the hospital. It is kind of shocking that people who may not have been able to get help at home can now get help at home during the pandemic."
Speedy discharge must be balanced against safety concerns, he says. "We find that the majority of patients want to get out of the hospital the next day, but if they have significant comorbidities or they do not have the appropriate resources and help at home, we don't send them home until those factors can be cautiously taken care of."
4. Technology utilization
Using telemedicine and robotic-assisted surgery are helpful during the coronavirus pandemic, Finn says.
"Telemedicine is certainly convenient, and it decreases the contact between the patient and the doctor, which decreases the risk of coronavirus exposure. … Robotic surgery, which I have been involved with for several months, decreases blood loss and post-operative pain. The smaller incisions also help patients to go home earlier."
5. Renegotiate implant contracts
To help address the financial challenges associated with the pandemic and elective orthopedic surgery, hospitals should try to renegotiate vendor contracts for joint implants, he says. "The implant costs that the hospitals pay can be so high that it affects the ability to achieve any profit. The implant costs can be higher than the reimbursement that the hospital receives from Medicare. That is where the big dollars are in the cost of hip and knee replacements."
To renegotiate these contracts, hospitals need to stress the necessity of cost-sharing during the pandemic, Finn says. "Hospitals need to say to the vendors of implants, which have a very high profit margin, 'Look, you are going to have to cost-share if we are going to continue to do joint replacements.'"
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Beyond hospital bed capacity during the pandemic, there are several barriers to elective orthopedic surgery such as financial pressures on hospitals and physician practices.
During the pandemic, orthopedic surgeons should stay up-to-date on evidence-based practice such as guidance from the American College of Surgery.
To ease financial pressures, hospitals can help to continue elective orthopedic surgery by renegotiating contracts for joint replacement implants.