Source: CMS

CMS Adult Elective Surgery and Procedures Recommendations:

Limit all non-essential planned surgeries and procedures, including dental, until further notice

To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. Attached is guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. These considerations will assist in the management of vital healthcare resources during this public health emergency.

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, we are recommending that all non-essential dental exams and procedures be postponed until further notice.

A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease. Decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have direct responsibility to their patients. However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered. These recommendations are meant to be refined over the duration of the crisis based on feedback from subject matter experts. At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, while case-by-case evaluations are made, we suggest that the following factors to be considered as to whether planned surgery should proceed:

  • Current and projected COVID-19 cases in the facility and region.
    • Consider the following tiered approach in the table below to curtail elective surgeries. The decisions should be made in consultation with the hospital, surgeon, patient, and other public health professionals.
  • Supply of PPE to the facilities in the system
  • Staffing availability
  • Bed availability, especially intensive care unit (ICU) beds
  • Ventilator availability
  • Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery
  • Urgency of the procedure.page2image1767781280page2image1767781568page2image1767781856

Tiers

Action

Definition

Locations

Examples

Tier 1a

Postpone surgery/ procedure

Low acuity surgery/healthy patient
outpatient surgery Not life threatening illness

HOPD*
ASC**

Hospital with low/no COVID- 19 census

-Carpal tunnel release
-EGD -Colonoscopy -Cataracts

Tier 1b

Postpone surgery/ procedure

Low acuity surgery/unhealthy patient

HOPD
ASC
Hospital with low/no COVID- 19 census

-Endoscopies

Tier 2a

Consider postponing surgery/procedure

Intermediate acuity surgery/healthy patient-
Not life threatening but potential for future morbidity and mortality. Requires in-hospital stay

HOPD
ASC
Hospital with low/no COVID- 19 census

-Low risk cancer -Non urgent spine & Ortho: Including hip, knee replacement and elective spine surgery

-Stable ureteral colic

-Elective angioplasty

Tier 2b

Postpone surgery/ procedure if possible

Intermediate acuity surgery/unhealthy patient-

HOPD
ASC
Hospital with low/no COVID- 19 census

Tier 3a

Do not postpone

High acuity surgery/unhealthy patient

Hospital

-Most cancers

-Neurosurgery

-Highly symptomatic patients

Tier 3b

Do not postpone High acuity surgery/unhealthy patient Hospital

-Transplants

-Trauma

-Cardiac w/ symptoms

-limb threatening vascular surgery