Return of Elective Surgeries in a COVID-19 Environment

On April 17, the AAOS issued a list of “Guiding Principles” to its members in order to help them navigate the pandemic and how to reopen for elective procedures. (The PDF of this can be located at bit.ly/odt200590). The recommendations were outlined in five points: safety of patients; safety of healthcare personnel and staff; adherence to the Centers for Disease Control and Prevention guidance and recommendations, along with those from federal, state, and local levels; decisions at the local level, appropriate to each facility based on community needs, resource availability, and virus incidence and prevalence; and legal restrictions.

The document also covers important considerations such as whether there is a sustained reduction of new COVID-19 cases in the area, testing availability for patients, contact tracing capabilities, and patients in high-risk categories. Finally, a fair amount of information is provided on the virus, testing, telehealth, and other factors that could be of interest to clinicians. It’s fairly extensive, which is great, as communication during this time is paramount. There is a notable absence, however, of any mention of dealing with or addressing orthopedic device suppliers and/or representatives.

I recently spoke with an executive at a leading medical device firm. We were discussing the pandemic and the industry’s response, along with other related topics. One thing he mentioned struck me; it wasn’t something I had heard anyone else mention. That is, what was going to happen in the second half of the year or the fourth quarter when hospitals and surgery centers are ramping up to return to some sense of normal operation? What will the demand look like for the medical device firms who supply the necessary technologies for surgeries that could potentially be exceeding normal levels? That’s what keeps him up at night. Will his company have the personnel and resources in place to fulfill that demand?

In early April, Orthospinenews.com featured an article that gave surgeons and orthopedic industry representatives an opportunity to share experiences, concerns, and ideas. Kristy Weber, M.D., chief of Orthopaedic Oncology at Penn Medicine and the immediate past president of AAOS, said, “In three months, if we are able to start seeing routine patients in clinic and operate on patients with musculoskeletal problems, we will do so to the maximum capacity of the system. Our faculty and staff are prepared to ramp up efforts to manage the backlog of patients by adding late clinics and Saturday surgeries. However, we will need to work within the capacity of the system in terms of available resources (OR/clinic staff, PPE, equipment) which may be depleted after months of high intensity care to affected patients.”

The question remains whether orthopedic device makers will be able to respond in kind to the increased schedule and patient load across all facilities to provide product for such demand. I’m not privy to the specifics, but I can’t imagine many implants are being sent to hospitals or surgery centers at the moment. As such,  their manufacturing has likely decreased significantly. Getting back up to speed will certainly be a challenge; will it be possible to expect even more product sent than normal?

Further, what about the surgical kits for this schedule? Will OEMs increase the number of kits they deploy for all these procedures? Is there time to transition to a disposable solution to avoid any need for cleaning/sterilization protocols followed by a redeployment for the next procedure? Even if there was time for companies to make the switch to a single-use instrument option, could those manufacturers suddenly supply the companies coming to them for their products?

Christopher Bono, M.D., executive vice chair of the Department of Orthopaedic Surgery at Massachusetts General Hospital and professor of Orthopaedic Surgery at Harvard Medical School, said, “While if our surgeons were told that next week, the COVID crisis was over and we can start our elective practices again, we’d be ready full force. Offer us operating rooms that run till 9 at night and weekends and we’ll fill them; extend our clinics to decompress the backlog and we’ll staff them.” Sure, Dr. Bono, but will you have the implants for those increased procedures?

What is your company doing to prepare for a return to normalcy with regard to supporting surgeons and hospitals who are apparently expecting to simply be able to increase OR capacity and get to work on the backlog this pandemic has created? If you have ideas, strategies, or suggestions you’d like to share, send them to me. As always, feel free to send any comments on this topic my way as well. 

Sean Fenske, Editor-in-Chief
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