Clinical Considerations for Resuming Elective Surgery Released by The American Academy of Orthopaedic Surgeons

The American Academy of Orthopaedic Surgeons (AAOS) has released clinical considerations for navigating the COVID-19 pandemic including the decision to resume elective surgery. The considerations, which include five guiding principles, come as the Centers for Medicare and Medicaid Services (CMS) issued recommendations for re-opening America’s Health Care Systems.

“CMS has once again offered a helpful, nationwide framework for entering this new phase of the pandemic, and we applaud the agency for recognizing the significant differences in disease incidence and prevalence in each state and locale,” said AAOS President Joseph A. Bosco III, MD, FAAOS. “Now as individuals across the country begin evaluating these recommendations and implementing them in their practices, the AAOS is offering additional detail for prioritizing the safety of our patients and members.”

The AAOS clinical considerations cover COVID-19 testing, risk stratification, telehealth services, as well as in-person services and resuming elective surgery. They note that orthopaedic surgeons should continue to follow federal, state, and local public health guidance and were formed with the below guiding principles.

Guiding principles:

1. First Priority: The safety of patients is and must be of the highest priority when considering the provision of health care services, items and procedures during the COVID-19 pandemic.
2. Second Priority: The safety of health care personnel and staff should be of next highest priority, after accounting for patient safety, when considering the provision of health care services, items, and procedures.
3. Adhere to the Centers for Disease Control Prevention (CDC), and relevant federal, state and local public health guidance and recommendations; the safety of our patients and staff members is paramount.
4. Decisions should be locally based, as factors vary by locale; this includes incidence, prevalence, patient and staff risk factors, community needs, and resource availability (to include intensive care unit (ICU) beds, hospital beds, ventilators, and personal protective equipment (PPE)).
   1. It is imperative to accurately determine if the disease burden curve trajectory in your local community is increasing, flattening, or decreasing, as well as the reproductive number; greater than, equal to, or less than one.
5. Follow legal restrictions: many states and locales have mandated shutdowns and stay-at-home orders; it is important to adhere to these legal requirements.

View the full AAOS Clinical Considerations here: