Panel of Specialists Issues New Guidelines For Elective Surgeries

F.J. Thomas

Sarasota, FL ( – A new extensive set of guidelines developed by the International Consensus Group (ICM) to address resuming elective surgeries in the midst of the ongoing COVID-19 crisis has been published in The Journal of Bone & Joint Surgery.

A team of 77 physicians comprised of orthopedic, infectious disease, microbiology and virology, and anesthesia specialists answered questions, made recommendations, and then voted twice to create the resulting final set of guidelines. The participants were selected based on their expertise in infection prevention.

The guidelines addressed a variety of areas in managing an elective surgery candidate, from prior to surgery through the post-operative period. The recommendations addressed selecting surgery patients, guidelines for symptom screening, prior testing, as well as guidance for ventilator use, and sterilization protocols. Recommendations were grouped into three categories: “strong,” “moderate” or “weak.” Of the 30 total recommendations, 16 were classified as “strong.”

When asked about how a facility knows they can resume elective procedures, the panelist responded with the following criteria:

  • Regional lockdown has been lifted
  • Decrease in COVID-19 cases
  • The facility has the ability to keep COVID-19 cases separate from non COVID-19 patients
  • Adequate supply of PPE and testing kits
  • Can effectively implement social distancing at all times
  • Adequate stockpile of supplies in the event of a second wave

When asked whether a patient that has tested positive for SARS-CoV-2 should have an elective procedure, the panelist gave a “weak” recommendation that if possible, the procedure should be re-scheduled until they have recovered and are no longer showing signs. The panel also indicated that there have been some cases in which a COVID-19 patient has become re-infected with the virus.

During the preoperative period, the panelists suggested getting the patient’s complete travel history, as well as occupation and a thorough contact history. Obtaining preoperative testing was recommended at 3 to 7 days prior to the procedure. The panel recommended RT-PCR testing for SARS-CoV-2 citing enhanced sensitivity.

Intraoperative recommendations included enhanced ventilation capable of a minimum of 20 air changes per hour in the operating suite, installation of HEPA air filters, and limiting staff and equipment to only essential. The panel strongly recommended not using standard surgical helmets citing that the fans in the helmets and the helmets themselves cannot be sterilized between uses and can harbor viruses. Facemasks such as an N95 with a face shield or goggles were recommended, as well as neck coverings with extensions inside the surgical gown.

the full list of recommendations is available on The Journal of Bone & Joint Surgery website.

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