6 Factors to Consider when Rebooting Surgery

In the last few weeks elective surgery has resumed virtually everywhere. A recurring challenge is prioritizing pending surgeries. If you had 100 planes on the ground waiting to take off, how do you determine which take off first? While it varies practice to practice, we have found 6 common factors considered when prioritizing surgeries.

If a delay in surgery compromises outcome or increases distress, these patients tend to take higher precedence when scheduling. About 90% of our clients consider this the most important factor. 

Prior Surgery Date
Patients expect to receive service according to where they were in cue before COVID related surgery stoppages occurred. Managing these expectations is incredibly important as surgeries are rescheduled. Many clients consider this the second most important factor. 

Facility limitations
For those operating out of multiple facilities, each facility may have its own set of policies for resuming surgeries. These varying policies can make one's head spin. Moreover, resource scarcity can preclude pre-COVID operating volumes. Recognizing these limitations can help one also prioritize surgical cases and when they need to go.

Patient Health
Given the potential impact of COVID infection perioperatively, certain patients should consider delaying their surgeries, particularly if they test COVID-19 positive. NEJM reported certain factors such as smoking, age >65 years, arrhythmia, heart failure, coronary disease, and COPD are associated with up to 3 fold increase in mortality. Educating about the importance of strict social distancing and infection control are essential to minimize complications perioperatively. Some practices are suspending surgeries in high risk patients altogether.  

Financial Reimbursement of Surgery
As financial reserves have been depleted in the pandemic, maximizing cash flow and profitability have become increasingly important. Some clients are creating operating room days dedicated to specific high margin procedures to enhance efficiencies and get cash flowing again. Surgical practices with less than 10 surgeons seem to be the most sensitive to this factor. 

Surgeon Preference
Some surgeries present a higher risk to patients than others. Consequently many surgeons are judiciously resuming lower risk procedures first or delaying high risk procedures. Surprisingly, only 15% of our participating clients consider this an important factor. When several surgeries are pending, prioritizing cases can make your head spin. Moreover, as the public re-opens, it is unclear whether a COVID-19 infection resurgence will require another surgery suspension. We recommend each surgeon rank the importance of each criteria and accordingly create rank scores and lists of pending surgeries. This makes it easy to respond to patients with ever evolving public health guidance and track where patients stand.

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