The COVID-19 pandemic has led to the cancellation or postponement of thousands of elective surgeries, including pediatric spine surgeries. Restrictions were initially put in place to prevent the spread of the novel coronavirus to doctors and patients, keep ICU beds open for serious COVID-19 cases, as well as to preserve the supply of personal protective equipment (PPE) for frontline workers.
Now that supplies are more secure, and the number of COVID-19 hospitalizations are at a more manageable level many hospitals are looking to prioritize the backlog of elective surgeries that have built up over the first half of 2020.
A group of spine surgeons from the Children’s Hospital of Philadelphia (CHOP) have authored a framework for prioritizing elective pediatric spine surgeries as restrictions are relaxed.
The guidelines, “What’s Important: Managing the Impact of Coronavirus on Pediatric Spine Surgery” were published in The Journal of Bone and Joint Surgery.
They recognize both the urgency of the intervention and the resource utilization to inform classification of surgeries. The authors classify surgeries into four classes with the first being emergency surgeries. Class 2 surgeries include urgent cases that need to be addressed within a short timeframe. Unfortunately, delaying surgery for some elective pediatric spine procedures, such as deformity correction, has been shown to lead to increases in perioperative risks, incidence of adverse events, or poorer clinical outcomes.
These surgeries where a delay of several months would lead to less-optimal outcomes are included in Class 3. The final class of surgeries include cases where a delay will not impact the outcome, children have competing risks of medical conditions, or the surgery will require more extensive resource use, including PPE, personnel, or ICU length of stay.
The surgeons recommend that Class 1 cases be addressed regardless of COVID-19 case counts, but using as much precaution as possible by screening for the virus and using enough PPE to protect caregivers. As community spread lessens, they recommend addressing additional surgery classes, with Class 4 surgeries occurring only once the pandemic has reached a low point. They suggest considering extending hours or rescheduling patients to weekends to address the backlog and to help with social distancing recommendations.
Jason Anari, M.D., a pediatric surgeon and first author of the publication, commented on the framework saying, “Although many families historically pick surgical dates that are based on school, sport seasons, or vacation schedules, we support the creation of a new urgency list to help guide rescheduling while also minimizing potential risk to patients. Having a plan of action to ramp up in a safe and organized fashion benefits everyone: the health system, surgeons, care teams, and, most importantly, patients.”
