Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty O
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RESPONSE TO COVID-19/COMMENTARY
Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty Orthopedic Hospital in New York City Ellen M. Soffin, MD, PhD & Marie-Jacqueline Reisener, MD & Andrew A. Sama, MD & James D. Beckman, MD & Gregory A. Liguori, MD & Darren R. Lebl, MD & Federico P. Girardi, MD & Frank P. Cammisa, MD & Alexander P. Hughes, MD
Received: 13 May 2020/Accepted: 23 July 2020 * Hospital for Special Surgery 2020
Keywords COVID-19 . coronavirus . spine surgery . elective surgery . anesthetic care . Institutional guideline Introduction During the March 18, 2020, White House Coronavirus Task Force Press Briefing, representatives from the Centers for Medicare and Medicaid Services (CMS) and the US Surgeon General’s office announced a plan for all “elective” and “non-essential” surgeries and procedures to be delayed in order to enhance response to coronavirus disease 2019 (COVID-19) [21]. In the three-tiered CMS hierarchy, spine surgery was included in tier 2a, along with a recommendation to “consider postponing surgery” for “non-urgent spine” and “elective spine” procedures [8]. Deferring these services conserves beds, ventilators, personal protective equipment (PPE), and essential workforce and was therefore a priority for hospitals preparing for or experiencing a surge of patients with COVID-19. Postponing elective surgeries may Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09786-0) contains supplementary material, which is available to authorized users. E. M. Soffin, MD, PhD : J. D. Beckman, MD : G. A. Liguori, MD Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA M.-J. Reisener, MD : A. A. Sama, MD : D. R. Lebl, MD : F. P. Girardi, MD : F. P. Cammisa, MD : A. P. Hughes, MD (*) Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA e-mail: [email protected]
have minimized additional risk of exposure through social distancing, further protecting patients and healthcare workers. The CMS recommendations outlined several factors that surgeons may consider, including patient risk, availability of beds, staff and equipment, and the urgency of the procedure, but they lacked a clear framework to assist operative decision-making. Translating the CMS recommendations into practical management and triaging of patients for surgical vs. nonsurgical treatment have carried significant clinical and ethical challenges for spine surgeons. Which cases were “essential”? Which could wait? How could we temporize the condition of patients waiting for surgery during the surge of critically ill patients in the pandemic? Conversely, the decision to operate required comprehensive anesthetic and peri-operative protocols for patients with known or suspected COVID-19. Such protocols had to achieve dual goals of protecting patients and practitioners, while co
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