Understanding Elective Surgery Restrictions During the COVID Crisis

What is the purpose of postponing elective surgery during the COVID-19 crisis?

I am sure you have heard lots of discussion about postponing elective surgery during the COVID-19 crisis. The purpose is three-fold.

1. In doing so, we are able to preserve valuable resources such as gowns, gloves and masks for our frontline health care workers who need them so desperately.
2. We can free up hospital beds by making sure these patients don’t end up in the hospital after surgery. Although uncommon in sports medicine, after many orthopedic procedures patients often spend one or two nights in the hospital, which limits the amount of rooms available to patients who are sick from the virus.
3. Postponing elective procedures complies with social distancing recommendations by avoiding crowded family waiting rooms, and interactions between staff and patients, often working in small spaces.

What is elective surgery?

The definition of “elective surgery, in fact, has evolved during the period of the crisis. Further, because the severity of the impact is different among different areas of the country, that definition may be different in a large city compared to a more rural area. In Chicagoland, where we are expecting a large surge of patients over the coming weeks, that definition has adopted a strict form limiting any surgical cases to those that are required to preserve life or limb. Suffice it to say, very little surgery is happening, and reserved only for those who life is truly immediately dependent on it! In other areas however, a more broad definition is in force, including any procedure where a delay may cause a change in outcome for the patient. A good example may be an acute tendon rupture, where waiting four to eight weeks for surgery, may result in a suboptimal outcome, or put the patient at increased risk of complications such as stiffness.

If you are awaiting an elective procedure, what can you do during this down time to address your symptoms?

Procedures that allow return to sport:

The answer really depends on the nature of your condition. For some, elective sports medicine procedures are being recommended to allow a patient to return to sport. Some examples may be and ACL reconstruction or Tommy John procedure. For those patients, avoidance of the sporting activity is all that is necessary. That means pitchers with a ligament injury would continue to avoid throwing until the surgery can be safely performed. Similarly, those with ACL tears may avoid jumping, cutting and pivoting sports until the surgery can be performed. Often, your surgeon may provide recommendations for a home exercise program which can maintain joint range of motion and strength to facilitate recovery after surgery.

Procedures for pain or loss of function:

For others, however, surgery may be indicated because of pain or loss of function that interferes with activities of daily living. For these patients, the delay is necessary but unfortunate, and the key is to minimize symptoms during the waiting period. Examples may include a meniscus tear or a rotator cuff tear. Some tips to help you manage symptoms during this time include:

• Maintain contact with your physician. Most physicians are doing telemedicine visits via online portals to allow continued patient care. Dr. Verma an Midwest Orthopedics at Rush are able to provide telehealth schedule. Please contact us at vermapractice@rushortho.com
• A home exercise program can be helpful in reducing pain and improving function. Like most doctors, the physical therapist at Midwest Orthopedics at Rush are offering telehealth visits to provide ongoing care to patients. Again please contact our office for scheduling.
• Medications can be helpful when needed. Focus on an over the counter pain reliever such at Tylenol (acetaminophen) or an anti-inflammatory such as Alleve or Advil (Naprosyn or ibuprofen). Both can be helpful to control pain symptoms, and are not habit forming like narcotic pain medications. In rare cases, your physician may recommend stronger prescription based pain medications for severe pain, to be used over short time periods.
• Ice, Heat or topical creams. Ice can be very helpful to control inflammation and reduce pain. A general recommendation is 30 min of icing used every two hours. Similarly, heat can be helpful particularly in cases of stiffness or muscle spasm, to relieve and release muscles. Topical anti-inflammatory creams such as aspirin based or voltaren based creams can also be helpful to control local inflammation. Many are available over the counter at your local pharmacy.

Will it be safe to have surgery in the future?

Ultimately, like all crisis situations, this one will come to end thanks to our front line health care providers who are working tirelessly to help those in need, and to provide our government officials with safe recommendations regarding timeframes and protocols to return to normal activity. Many may have concerns about the safety of undergoing surgery in the future. Keep in mind, that multiple organizations like the Center for Disease Control (CDC), American Academy of Orthopedic Surgeons (AAOS), and the Ambulatory Surgery Center Association (ASCA) are all monitoring the situation with patient safety as the highest priority, and will provide guidance and recommendations regarding safety upon return.

For now, for the health and well being of our entire community, observe social distancing and stay at home recommendations, keep in contact with your health care providers, and stay safe and healthy.