The Centers for Medicare & Medicaid Services issued its guidance on nonessential surgeries amid the COVID-19 outbreak, recommending “that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed.” Delaying surgery means conserving equipment, resources, and healthcare professionals, as well as minimizing the risk of spreading the virus.
Orthopedic surgery may not come to mind when considering essential surgeries. However, in a recent interview, Alan Hilibrand, MD, vice chairman for academic affairs and faculty development for the department of orthopedic surgery and co-director of spine surgery at Rothman Orthopaedic Institute in Philadelphia, explained how his institution is handling the COVID-19 breakout and explained the significance of some essential orthopedic surgeries.
Speaking with Becker’s Spine Review, Dr. Hilibrand reiterated that his hospital is currently only performing essential procedures. Certain policies the hospital has implemented—including changing office hours to telehealth and telemedicine visits—may remain part of the institute’s normal routine even when the COVID-19 pandemic is over: “Anyone who can work from home works from home and staff who need to be here are only in to the extent they need to be.”
In-person appointments are tapering off, but certain patients must continue to be seen in person, including acute and postoperative patients, as well as those with complex issues that must be examined physically. But, when possible, follow-up takes place over the phone.
“A lot of follow-up patients who have had surgery and nonsurgical patients who are doing fine can be dealt with over the phone. Even if there’s a need for updated imaging, that can all be reviewed online,” he said.
Which Surgeries Must Go On?
Dr. HIlibrand acknowledged that the financial repercussions will have an impact and will not resolve themselves as soon as things go back to business as usual. However, taking care of employees is Rothman Orthopaedic Institute’s first priority.
“Thankfully as a large organization that doesn’t carry any debt, we believe that we can weather this storm and protect our employees but things will be difficult. Inevitably, all of us will see much less income. From top to bottom, all physicians, management and employees,” he said. When it comes to orthopedic care during this time, Dr. Hilibrand said that some surgeries must go forth as planned.
“While people think about orthopedic surgery as elective surgeries like having a hip or knee replaced or an [anterior cruciate ligament] reconstructed, there’s a lot of essential surgery that orthopedic surgeons do, like fixing tendon ruptures and fractures, taking care of infections and patients who have significant neurologic deficits. These services need to continue to be provided. We can’t just all go home and not provide services to patients who need them,” he said. “The challenge of this pandemic is for us to be able to do all those things safely and not put undue stress on a healthcare system that may face substantial burdens to provide other types of care in the next month.”