The primary outcome was the rate of surgical procedures. Kaiser Permanente researchers have good news for patients, surgeons, anesthesiologists, and hospital administrators who have had to put off elective surgery because of a positive COVID-19 test. Finelli L, Gupta V, Petigara T, Yu K, Bauer KA, Puzniak LA. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. Compared with the initial pandemic response, in March through April 2020, there are limited data to fully explain the rapid and sustained rebound of most surgical procedure rates during the COVID-19 surge in the fall and winter of 2020, when the volume of patients with COVID-19 throughout the US increased 8-fold. The aim of these guidelines is to provide consensus recommendations . These recommendations for stopping elective procedures were in the context of widespread uncertainty regarding disease management, transmission risks, PPE availability, inadequate testing resources, and disaster planning to prioritize access to ICU beds and ventilators. Please work with your doctor's office to determine when is an appropriate time to return for your rescheduled visit or procedure. You are a physician leader on a senior committee that is responsible for your hospital's Covid-19 . For elective surgery, even for non-COVID positive patients, the risks and benefits of the procedure should be weighed with the increased risk of anesthetizing a child with an active infection. Exposures: 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. Visitors may be restricted from hospitals and nursing homes at this time to limit them from bringing COVID-19 into a facility and to also prevent their exposure to sick patients. There was a correlation between state volumes of patients with COVID-19 and surgical procedure volume during the initial shutdown (r=0.00025; 95% CI, 0.0042 to 0.0009; P=.003), but there was no correlation during the COVID-19 surge (r=0.00034; 95% CI, 0.0075 to 0.00007; P=.11). Our top priority is providing value to members. American College of Surgeons website. Sidney Le, MD. The American Society of Anesthesiologists maintains a slightly different viewpoint, recommending that elective surgery be deferred for 7 weeks in. ; CDC Prevention Epicenters Program . COVID 19: elective case triage guidelines for surgical care. For low-level exposure, you may require restriction for 14 days with self-monitoring. Our findings suggest that in the absence of national recommendations and state government policies, increased rates of patients with COVID-19 were likely not the strongest factor associated with surgical procedure volume. We note that US in-hospital mortality for patients testing positive for COVID-19 peaked in April 2020 (19.7%) and decreased in all age groups by 50% by June 2020.24 Infection control procedures were associated with the near disappearance of nosocomial transmission and infections among health care workers.24,25 Financial factors were also likely associated with restoration of surgical procedure volume quickly, but an economic analysis was beyond the scope of this investigation, as was characterization of clinician and patient risk aversion or acceptance. The American College of Surgeons is dedicated to improving the care of surgical patients and safeguarding standards of care in an optimal and ethical practice environment. Since hospitals are able to continue to perform elective surgeries while the COVID-19 pandemic continues, determining the optimal timing of procedures for patients who have recovered from COVID-19 infection and the appropriate level . This study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies. In this cohort study of more than 13 million US surgical procedures from January 1, 2019, through January 30, 2021, there was a 48.0% decrease in total surgical procedure volume immediately after the March 2020 recommendation to cancel elective surgical procedures. References If COVID-19 testing is required, it should happen as close to the surgery or procedure as possible. All regression models included week-of-year fixed effects, and standard errors were clustered at the week level. Avoid emergency surgical procedures at night when possible due to limited team staffing. These findings suggest that health systems learned to adapt and were able to self-regulate, maintaining surgical procedure volume during the largest peak in volume of patients with COVID-19. A mean 7-day cumulative incidence rate was calculated for each epidemiological week and then the mean found over the initial shutdown period (ie, weeks 12-18 in 2020) and COVID-19 surge (ie, weeks 44 in 2020 through 4 in 2021). During the COVID-19 surge, most states maintained surgical procedures at or above the 2019 rate (Figure 3). Study reports drop in lung cancer screening, rise in malignancy rates during spring COVID-19 surge. . Critical revision of the manuscript for important intellectual content: Rose, Eddington, Trickey, Cullen, Morris, Wren. Preoperative vaccination, ideally with three doses of mRNA-based vaccine, is highly recommended, as it is the most effective means of reducing infection severity. This website and its contents may not be reproduced in whole or in part without written permission. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. In a prospective cohort study conducted in October 2020 (COVIDSurg Collaborative and GlobalSurg Collaborative, There are no published data on perioperative risk following infection with the Omicron variant. Deidentified claims were provided by Change Healthcare, a US health care technology company, for use limited to COVID-19 research. Teens Are in a Mental Health Crisis: How Can We Help? Each decision should be made at the individual level, and we want to stress that the patient is an active participant in their care.. Elective surgery. We compared procedure rates by major category, subcategory, and 12 procedures of interest during 2 key periods, defined as initial shutdown (epidemiological calendar weeks 12-18, 2020; March 15-May 2, 2020) and subsequent COVID-19 surge (week 44, 2020, to week 4, 2021; October 25, 2020-January 30, 2021). Statistical significance was assessed at the level of P<.05, and P values were 2-sided. Joint statement: roadmap for resuming elective surgery after COVID-19 pandemic. Six months from now, we may have different guidelines as more information becomes available. During the ongoing COVID-19 pandemic, elective surgery often has been misunderstood to mean an operation that may not really be needed. The health care workforce is already strained and will continue to be so in the weeks to come. 2023 American Society of Anesthesiologists (ASA), All Rights Reserved. Examples may be cataract surgery, knee or hip replacements, hernia repair, or some plastic or reconstructive procedures. This creates a staff shortage to assist during surgery. We analyzed surgical IRR as a function of COVID-19 infection burden. Are you confused by the term "elective surgery"? The study, published online Dec. 8 in JAMA Network Open, contradicts the assumption that the COVID-19 pandemic has continually . You and your health care team should practice the CDC recommendations, including frequent handwashing for at least 20 seconds, social distancing of at least six feet, and avoiding visitors and groups. To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of . However, this material is provided only for informational purposes and does not constitute medical or legal advice. American College of Surgeons . Surgical procedure volume during the 2020 initial COVID-19related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Your hospital should develop a prioritization strategy based your community and immediate patient needs. 1995-2023 by the American Academy of Orthopaedic Surgeons. We also performed an analysis to evaluate specific procedures within major categories; these specific procedures are referred to as subcategories. If you can, call your doctor first to be screened to see if you have any symptoms of COVID-19; fever, cough, diarrhea or trouble breathing.3 If you do, then they will direct you to the correct location where teams in protective equipment will be ready and test you, if appropriate, for COVID-19. This equipment is in short supply right now and is desperately needed by health care providers in the hardest-hit areas caring for COVID-19 patients. In contrast, from 2019 to 2020, the rate of cesarean delivery procedures did not change (32345 procedures vs 30398 procedures; IRR, 0.98; 95% CI, 0.94 to 1.03; P=.42) and the rate of surgical procedures for bone fractures decreased by 14.1% (25429 procedures vs 19887 procedures; IRR, 0.86; 95% CI, 0.78 to 0.94; P=.001). Patients and their loved ones or caretakers might have an undiagnosed case of COVID-19. March 27, 2020. Four weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms. https://covid19researchdatabase.org. Resident Orthopaedic Core Knowledge (ROCK), The Bone Beat Orthopaedic Podcast Channel, All Quality Programs & Practice Resources, Clinical Issues & Guidance for Elective Surgery. If their occupancy is above 95%, they are additionally required to stop elective surgeries at hospital-owned ambulatory surgical . Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. . https://www.facs.org/media/press-releases/2020/lung-screening-121720, https://www.facs.org/media/press-releases/2021/covid-vaccine-072621, https://www.facs.org/covid-19/toolkits/talk-it-up. Your doctor will determine if your condition will worsen without the surgery and whether other treatments are available. Whether these missing operations were partly associated with the 550000 to 660000 pandemic-related deaths16; decisions to defer or forgo care for nonurgent conditions, such as inguinal hernia or rotator cuff tear; or successful nonoperative management of conditions potentially requiring surgical treatment, such as appendicitis and diverticulitis, is unknown and could be a fruitful area of future research. Received 2021 Jul 20; Accepted 2021 Oct 12. Throughout California, as COVID-19 infections deplete their staff of nurses, anesthesiologists and other essential workers, hospitals are canceling or postponing so-called "elective" surgeries to repair injured knees and aching back, remove kidney or bladder stones, and repair cataracts or hernias, among other procedures. Clinicians and patients should engage in shared decision making regarding surgical timing, informed by the patients baseline risk factors, severity and timing of SARS-CoV-2 infection, and surgical factors (clinical priority, risk of disease progression, and complexity of surgery). What is the minimum level of pre-operative testing that should be done prior to elective cases? Become a member and receive career-enhancing benefits, www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html, https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html, https://www.facs.org/covid-19/clinical-guidance/triage, https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html, https://jamanetwork.com/journals/jama/fullarticle/2763533, https://www.aorn.org/guidelines/aorn-support/covid19-faqs. Accepted for Publication: October 12, 2021. Attached is guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. This requires daily temperature monitoring. All regression models included week-of-year fixed effects, and standard errors were clustered at the week level. For some, the risks of waiting to have the surgery may be greater than delaying it, while for others it may be smarter to wait. Additionally, keeping health care workers protected with access to proper PPE, in addition to a fully vaccinated health care work force, will help ensure that hospitals can handle surges in COVID-19 patients while maintaining access to surgical care. Of note, ENT procedures by nature place the surgeon in closest contact with the patient airway and secretions and represented the one category of procedures that did not return to 2019 levels. The decisions should be based on local case incidence, ongoing testing of staff and patients, aggressive use of appropriate PPE and physical distancing practices.". Commercial claims are available in the data set within 1 day of claim processing and are updated as they are adjudicated. There are three adult services at The Johns Hopkins Hospital: "Dandy," "Cushing" and "Brem," each comprised of attendings from the tumor, spine, vascular and functional services. We defined 11 major surgical procedure categories and 25 subcategories of CPT codes, guided by the HCUP Clinical Classification system. The most recent pandemic the US had faced, the 2009 influenza A (H1N1) virus pandemic was associated with mortality (0.02%) and hospitalization (0.45%) rates of less than one-half of 1 percent of the estimated 60.8 million people infected.3 In contrast, COVID-19 was associated with unprecedented stress and demands on the New York City health system, with increased rates of mortality (9.6%) and hospitalization (26.6%).4 On March 13, 2020, the US president declared a national emergency, leading to a shutdown of all nonessential activities throughout the United States.5 The American College of Surgeons (ACS) and other major surgical specialty societies recommended minimizing, postponing, or canceling elective surgical procedures in mid-March and published guidelines for triage of elective procedures by surgical specialty.6,7 The Centers for Medicare & Medicaid Services (CMS) and US Surgeon General also issued statements and recommendations for postponement of nonessential surgical procedures.6,8 Recommendations were driven by concerns that continuation of elective surgical treatments could potentially compromise hospital and intensive care unit (ICU) capacity and result in shortages in personal protective equipment (PPE) supplies. Elective surgery should not take place for 10 days following SARS-CoV-2 infection, as the patient may be infectious and place staff and other patients at undue risk. Appendectomy was among the procedures most preserved during the shutdown but still demonstrated a statistically significant 28.8% decrease in volume (10581 procedures vs 7304 procedures; IRR, 0.71; 95% CI, 0.64 to 0.78; P<.001), while lower extremity amputation and cesarean delivery showed no statistically significant change from baseline. Spiteri G, Fielding J, Diercke M, et al.. First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020. Studies suggest that elective surgeries should be delayed, when possible. Elective surgery during the COVID-19 pandemic. Even a fully insured person is left out of pocket by up to $20,000 for a vaginoplasty performed in . In this case, the changes are significant. Rather, these findings suggest that health systems surgical services responded effectively and hospitals adapted elective surgical procedure policies based on local needs and resources. Elective surgery should not take place for 10 days following SARS-CoV-2 infection, as the patient may be infectious and place staff and other patients at undue risk. The timing of elective surgery after recovery from COVID-19 uses both symptom- and severity-based categories. Were 2 separate COVID-19 crises, one policy driven during the initial shutdown and the other occurring during the highest burden of infections, associated with changes in surgical procedure volume in the US surgical health system? The overall rate of procedures during the 2020 initial shutdown decreased by 48.0% compared with its corresponding period in 2019 (905444 procedures in 2019 vs 458469 procedures in 2020; IRR, 0.52; 95% CI, 0.44 to 0.60; P<.001) (Figure 1; eTable 1 in the Supplement). We all hope that this response is temporary. Non-emergency procedures require personal protective equipment such as masks, gloves and gowns. The .gov means its official. Organizations, including the ACS, continue to prepare recommendations for physicians treating patients including those with cancer. Elective surgery scheduling under uncertainty in demand for intensive care unit and inpatient beds during epidemic outbreaks. Communication with your health care provider in the interim is key. This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Surgical procedures in veterans affairs hospitals during the COVID-19 pandemic. DOI: 10.1080/01605682.2023.2198557 Corpus ID: 258262844; Elective surgery scheduling considering transfer risk in hierarchical diagnosis and treatment system @article{Dai2023ElectiveSS, title={Elective surgery scheduling considering transfer risk in hierarchical diagnosis and treatment system}, author={Zongli Dai and Jian-Jun Wang}, journal={Journal of the Operational Research Society}, year . Analysis of 25 surgical subcategories found more specific trends within the major surgical procedure categories (Figure 2B; eTable 2 in the Supplement): Cataract surgical procedures, with a decrease of 89.5% (13564 procedures vs 1396 procedures; IRR, 0.11; 95% CI, 0.11 to 0.32; P=.03), and joint arthroplasty, with a decrease of 82.1% (53328 procedures vs 9737 procedures; IRR, 0.18; 95% CI, 0.01 to 0.37; P=.001), had the largest decreases during the initial shutdown period. An Analysis Based on the US National Cancer Database. Though surgeons are well aware of these guidelines, its important for patients and their family members to understand the reasoning behind a decision to delay a surgery, even for a person who feels perfectly well. Non-emergent, elective medical services, and treatment recommendations. Please refer to the ASA-APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection for further information. During the course of the COVID-19 pandemic, orthopaedic surgeons have continued to provide critical emergency surgical care to patients safely and effectively. A large international study, published inAnaesthesia,showed thatkeeping surgery on hold for at least seven weeks after a positive coronavirus test was associated with lower mortality risk compared with no delay. Based on the weekly assessment conducted by the Department, the following facilities must stop performing in-hospital elective surgery. Baseline perioperative risk should be assessed with a validated tool. Elective surgery wait times surge in Victoria One of the biggest casualties of the COVID-19 pandemic in Victoria has been increasing elective surgery wait list times. American College of Surgeons website. A, During the initial shutdown period, all major surgical procedure categories except transplant had a significant decrease in volume compared with 2019. The American College of Surgeons website has training programs focused on your home care. Your surgery being delayed can lead to more complicated operations and longer recovery times because disease can progress during the delay. Supervision: Rose, Trickey, Cullen, Wren. Accessed November 17, 2021. Stanford Medicine researchers found that after the March 2020 COVID-19 shutdown, nonurgent surgery rates dropped, but within months they bounced back and remained at pre-pandemic levels, even as coronavirus infections peaked during the fall and winter of 2020.. Updated Statement: ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus (June 15, 2022) Updated Statement: ASA and APSF Joint Statement on Elective Surgery/Procedures and Anesthesia for Patients after COVID-19 Infection (February 22, 2022) American College of Surgeons. All rights reserved. Accessed January 24, 2022. A decrease was observed in groin hernia repairs (12378 procedures vs 2815 procedures; IRR, 0.23; 95% CI, 0.05 to 0.41; P<.001), thyroidectomy (2652 procedures vs 985 procedures; IRR, 0.38; 95% CI, 0.22 to 0.55; P<.001), spinal fusion (3859 procedures vs 1592 procedures; IRR, 0.42; 95% CI, 0.25 to 0.59; P<.001), laminectomy (3199 procedures vs 1512 procedures; IRR, 0.51; 95% CI, 0.34 to 0.68; P<.001), and coronary artery bypass graft (3099 procedures vs 1624 procedures; IRR, 0.61; 95% CI, 0.45 to 0.76; P<.001). We identified all incident professional claims with at least 1 Current Procedural Terminology (CPT) level I surgical code, as defined in a subsequent section. Ambulatory Surgery Center Association . Overall, there were approximately 670000 fewer surgical procedures in 2020 than 2019, representing a 10% decrease. This disease may be transmitted to the health care staff and others in the hospital. Each of these services is led by a chief resident and a junior resident. Residual symptoms such as fatigue, shortness of breath, and chest pain are common in patients who have had COVID-19 (10,11).These symptoms can be present more than 60 days after diagnosis (11).In addition, COVID-19 may have long term deleterious effects on myocardial anatomy and function (12).A more thorough preoperative evaluation, scheduled further in advance of surgery with special . The American College of Surgeons is dedicated to improving the care of surgical patients and safeguarding standards of care in an optimal and ethical practice environment. If you are having surgery or are pregnant and delivering a baby with no symptoms of COVID-19, you will be placed in a section of the hospital away from those who have the virus. Elective surgery is considered medically necessary, and may be required urgently, but is not conducted as a result of an emergency presentation. Consider nonoperative management whenever it is clinically appropriate for the patient. During the COVID-19 surge, all major surgical procedure categories, except ears, nose, and throat, were not different from 2019 procedure rates. Introduction. For your safety, and to ensure that resources, hospital beds, and equipment are available to patients critically ill with COVID-19, the American College of Surgeons (ACS) and the U.S. Centers for Disease Control and Prevention recommend that non-emergency procedures be delayed.1,2. Care options may include other treatments while waiting for a safe time to proceed with surgery. COVID data tracker. Bethesda, MD 20894, Web Policies They have not changed the recommendation to defer elective surgery for 7 weeks following infection, even in asymptomatic patients, unless risks of deferring outweigh benefits. A total of 13108567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. f::U3%7:;Y#/dcd?/ fX9Jc=BtQawpue[Lsigunq.] B|QnICN]^AR[[5K1%84'2'%0v"MYt6$m;)btq`DH@=0{WmoqP!A9w3,o(;tPsa&Rp8Qou)? Initial shutdown indicates March 15 through May 2, 2020; COVID-19 surge, October 25, 2020, through January 30, 2021; IRR, incidence rate ratio showing change in procedure volume from 2019 to 2020, estimated from Poisson regression by comparing total procedure counts during epidemiological weeks in 2020 with corresponding weeks in 2019; error bars, 95% CIs. For the best experience please update your browser. USA Today. Six months from now, we may have different guidelines as more information becomes available.. If a hospital ICU is full of COVID-19 patients, it means there's no room for other patients that may need ICU care following surgery, for example trauma patients. During the COVID-19 surge, surgical procedure volume was determined by individual hospitals and systems rather than national or local policy. This study found that the initial shutdown period in March through April 2020, was associated with a decrease in surgical procedure volume to nearly half of baseline rates. Copyright 1996-2023 American College of Surgeons, 633 N Saint Clair St, Chicago, IL 60611-3295. Rhee C, Baker M, Vaidya V, et al. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. However, if someone comes to the hospital after a car accident, we wont delay surgery because they had COVID.. These high-volume procedures were selected to be representative of surgical procedures that range from always elective to mixed elective and urgent to always urgent or emergent. There were more than double the number of deaths reported in the COVID-19-positive group versus the group with negative results. Surgical procedure volume was maintained at or above 2019 levels in most states, even those with the highest COVID incidence rates during the COIVD-19 surge. When the COVID-19 pandemic began, the AAOS supported recommendations to delay elective surgery. Test your knowledge of anesthesia fundamentals and try a sample question now to see why it's a member favorite! Surgical Procedure Volume by Subcategory During Initial Shutdown and COVID-19 Surge vs Prepandemic Rate, eFigure. A growing number of studies have shown a substantial increased risk in post-operative death and pulmonary complications for at least six weeks after symptomatic and asymptomatic COVID-19 infection. 313 2. Meaning This study suggests that delaying surgery after COVID-19 infection was associated with decreasing postoperative cardiovascular morbidity and should be a factor in shared decision-making between . Medical, Surgical, and Dental Procedures During COVID-19 Response. There was a decrease in surgical procedure volume across all major categories compared with corresponding weeks in 2019. This article describes some things you can do to help alleviate painful symptoms until your surgery can be rescheduled. We will be performing site maintenance on AAOS.org on May 3rd from 7:00 PM 9:00 PM CST which may cause sitewide downtime. Potentially lethal opioid drugs are being inconsistently prescribed to patients undergoing elective surgery, according to a study of patients attending a west of Ireland hospital. Hospitals and surgical centers recovered quickly after the initial shutdown, suggesting that adaptability, resiliency, increased knowledge of limiting transmission, and financial factors may have played a role in reestablishment of baseline surgical procedure volumes even in the setting of substantially increased COVID-19 disease burden. Become a member and receive career-enhancing benefits, https://www.facs.org/-/media/files/covid19/guidance_for_triage_of_nonemergent_surgical_procedures.ashx, https://www.facs.org/covid-19/clinical-guidance/resurgence-recommendations. COVID-19 rapidly spreads from person-to-person contact and is also transmitted as it can stay alive and contagious for many days on surfaces. Recommendations regarding the definition of sufficient recovery from the physiologic changes from SARS-CoV-2 cannot be made at this time; however, evaluation should include an assessment of the patients exercise capacity (metabolic equivalents or METS). In some subcategories, the rate of surgical procedures surpassed 2019 rates; for example, fracture surgical procedure volume increased by 11.3% during the surge (47585 procedures vs 48215 procedures; IRR, 1.11; 95% CI 1.04-1.19; P=.002) (eTable 2 in the Supplement). October 27, 2020. This included 6651921 procedures in 2019 (3516569 procedures among women [52.9%]; 613192 procedures among children [9.2%]; and 1987397 procedures among patients aged 65 years [29.9%]) and 5973573 procedures in 2020 (3156240 procedures among women [52.8%]; 482637 procedures among children [8.1%]; and 1806074 procedures among patients aged 65 years [30.2%]). The Oregon Health and Science University (OHSU) has developed new guidelines to help hospitals and surgery centers determine whether patients who have recovered from COVID-19 can safely undergo elective surgery. The following procedures were excluded: injections, biopsies, fine-needle aspiration, closed treatments without skin incision (eg, closed treatment of fracture), percutaneous procedures, gastroscopy, colonoscopy, bronchoscopy, and catheter insertions. the contents by NLM or the National Institutes of Health. If you were told you have had close contact with a person who was exposed to or has COVID-19, you may require 14 days self-quarantine with active monitoring. However, delaying elective services for more than a particular duration adversely affects disease outcomes. sharing sensitive information, make sure youre on a federal We want to provide this information to patients so they can have a discussion with their surgeons and providers, says Roberta Hines, MD, chair of Yale Medicine's Department of Anesthesiology. So that is why we recommend delaying surgery at least six weeks, so that your body is not still dealing with the effects of the virus.. A growing number of studies have shown a substantial increased risk in post-operative death and pulmonary complications for at least six weeks after symptomatic and asymptomatic COVID-19 infection. American College of Surgeons website. The American College of Surgeons website is not compatible with Internet Explorer 11, IE 11. Drafting of the manuscript: Mattingly, Eddington, Trickey, Wren. Cataract repair, bariatric surgical treatment, knee arthroplasty, and hip arthroplasty represented always elective procedures; laminectomy, spinal fusion, coronary artery bypass graft, groin hernia repair, and thyroidectomy represented mixed elective and urgent procedures; appendectomy, cesarean delivery, and lower extremity amputation represented always urgent or emergent procedures.
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