Return to Electives

[apoondoc]

And here are the brass tacks from a local ambulatory surgical center:

We will continue to screen all patients and staff for potential symptoms of COVID-19 prior to admission to the facility. Patients will be expected to wear a cloth face covering when arriving at the center, while all staff will be wearing a face mask while working in the facility. *In addition, upon admission all patients will be asked to sign the Provider Notice of Potential Exposure to Covid-19, which demands no international travel, no fevers, and no known contacts in the last 30 days, while also acknowledging the increased risk of operating during a national emergency.

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[EtherLord]

Anyone using the American College of Surgeons MeNTS scoring system? It's so subjective...

 

[deleted899865]

At my hospital electives have resumed. All patients are being tested for covid the day before. Urgent cases tested and surgery delayed until results.

 

[BLADEMDA]

At my hospital electives have resumed. All patients are being tested for covid the day before. Urgent cases tested and surgery delayed until results.

I wouldn't delay an asymptomatic patient who needs urgent surgery for Covid testing. I would do the case and wear an N95 mask, eye protection, etc.

 

[kmurp]

So ASA/APSF just came out with guidelines on testing. The ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus | American Society of Anesthesiologists (ASA)

In general , they recommend testing except for in low prevalence areas. The reference for this statement is a CDC influenza prevalence paper. Anyone care to take a stab at what is considered low prevalence based on the ASA statement?

 

[Ezrunner]

Ha i guess my hospital counts as low prevalence, we resumed elective surgeries last week. Following CDC guidelines for testing. We are a relatively isolated Texas town with peak cases around 45, one death. All of us are wearing N95, gown, eye shield for every case.

 

[BLADEMDA]

So ASA/APSF just came out with guidelines on testing. The ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus | American Society of Anesthesiologists (ASA)

In general , they recommend testing except for in low prevalence areas. The reference for this statement is a CDC influenza prevalence paper. Anyone care to take a stab at what is considered low prevalence based on the ASA statement?

My best guess is prevalence under 1% in your area. Certainly, you could argue for an even lower number.

Evidence Mounts for Greater COVID-19 Prevalence

Because a significant percentage of infected people don't show any symptoms, experts have known the real number of infections was likely to be higher than confirmed cases.

www.medscape.com

Hard-hit New York, the first state to do its own antibody testing, found an estimated 13.9% prevalence rate statewide, Gov. Andrew Cuomo said Thursday. The rate was even higher in New York City, at 21.2%.

The state randomly tested 3,000 people who were out shopping. Cuomo said the results may be high because they tested people who were out, not people who are isolating at home.

These early figures would lower the fatality to infection rate to .5%, Cuomo said. But he cautioned that the data is preliminary and that current fatality rates will go higher because they don't include at-home deaths.

 

[BLADEMDA]

I need to clarify my 1% number. I was taking the number of Covid + cases for an area and multiplying it by a factor of 10-15 to get an idea of the real prevalence. Based on that calculation, most low prevalence areas were less than 0.5% positive based on our current data.

Who lives in the places where coronavirus is hitting the hardest? | Brookings

A look at the demographics affected by COVID-19 in American places.

www.brookings.edu

 

[kmurp]

Don’t expect much but I emailed ASA one APSF for clarification on low incidence areas. The statement they issued is unclear to me (and I have no idea what our incidence is anyway). How does ASA define it?

 

[Angus Avagadro]

Our local hospital will resume elective procedures May 4 at 50% capacity. Patients will be tested. No Covid cases in ICU for several days.

 

[drmwvr]

At my hospital electives have resumed. All patients are being tested for covid the day before. Urgent cases tested and surgery delayed until results.

Same here....but we're not testing staff, which if we're going to the trouble of testing every single patient pre-op, would seem a no brainer.

 

[Justice4all]

Same here....but we're not testing staff, which if we're going to the trouble of testing every single patient pre-op, would seem a no brainer.

Because they don’t want the answer. It is more pervasive than we think.Let’s say 2-3 out of every 10 tests positive with 14 days of quarantine on top of low case volumes. Each hospital true colors will show and it’s all about money not life

 

[drmwvr]

Because they don’t want the answer. It is more pervasive than we think.Let’s say 2-3 out of every 10 tests positive with 14 days of quarantine on top of low case volumes. Each hospital true colors will show and it’s all about money not life

Well, I might counter by saying that anyone that doesn't get tested might not want the answer either. Free testing is ubiquitous and to not take advantage of it would seem odd even if asymptomatic.

 

[BLADEMDA]

Don’t expect much but I emailed ASA one APSF for clarification on low incidence areas. The statement they issued is unclear to me (and I have no idea what our incidence is anyway). How does ASA define it?

Low prevalence is less than 50 per 100,000 people from what I can gather. Since testing is limited right now I would use a lot lower than 50 and more like 10 per 100,000 people to be on the safe side.

California Coronavirus Map and Case Count

See the latest charts and maps of coronavirus cases, deaths, hospitalizations and vaccinations in California.

www.nytimes.com

As you can see the reported incidence is 5-6 per 100,000 but we know the real number is 10-20 X higher so "low" needs to be less than 10 per 100,000 to be on the safe side.

So, your group could NOT test for 1-3 weeks and then re-evaluate if the incidence starts creeping up to that 10 number. Also, the STAFF is a high risk group and if you don't test them then the whole thing is a joke IMHO.

 

[nimbus]

Also, the STAFF is a high risk group and if you don't test them then the whole thing is a joke IMHO.

We have wealthy areas of town where the prevalence is 30/100000 and another area 10 miles away where it is >300/100000. We draw patients from all those areas. We test all patients but are not testing or even temperature screening staff. Agree that it’s a joke.

 

[deleted126335]

We have wealthy areas of town where the prevalence is 30/100000 and another area 10 miles away where it is >300/100000. We draw patients from all those areas. We test all patients but are not testing or even temperature screening staff. Agree that it’s a joke.

We temperature screen staff. Right by the entrance to the hospital. My corner of the world it has been chilly. Every single day my temp has been below 30 degrees Celsius.


Sent from my iPhone using SDN mobile

 

[kmurp]

Low prevalence is less than 50 per 100,000 people from what I can gather. Since testing is limited right now I would use a lot lower than 50 and more like 10 per 100,000 people to be on the safe side.

California Coronavirus Map and Case Count

See the latest charts and maps of coronavirus cases, deaths, hospitalizations and vaccinations in California.

www.nytimes.com

As you can see the reported incidence is 5-6 per 100,000 but we know the real number is 10-20 X higher so "low" needs to be less than 10 per 100,000 to be on the safe side.

So, your group could NOT test for 1-3 weeks and then re-evaluate if the incidence starts creeping up to that 10 number. Also, the STAFF is a high risk group and if you don't test them then the whole thing is a joke IMHO.

Are you looking at the correct column (cases) and not the deaths column? In any case for my county, we are over 300/100,000 Of those who were tested. We aren’t allowed yet to open our ASC or hospital but when the ASC opens, we hope we can get access to tests for our patients 72 hours prior. We can’t yet access N95s so I’m hoping to do regional for almost all patients (ortho) and our providers all have their own N95s which we sadly will have to reuse.

 

[BLADEMDA]

Are you looking at the correct column (cases) and not the deaths column? In any case for my county, we are over 300/100,000 Of those who were tested. We aren’t allowed yet to open our ASC or hospital but when the ASC opens, we hope we can get access to tests for our patients 72 hours prior. We can’t yet access N95s so I’m hoping to do regional for almost all patients (ortho) and our providers all have their own N95s which we sadly will have to reuse.

I apologize as you are correct. The incidence of less than 150 Covid + people per 100,000 would be considered fairly low. If you are 300/100,000 then I would think testing should strongly be considered prior to elective surgery.

Below is the correct link to cases per 100,000.

U.S. states with the highest COVID rates 2023 | Statista

As of Mar. 2023, two U.S. states had COVID rates higher than 42 cases per 100 population. Maryland had the lowest rate of cases.

www.statista.com

 

[Robotic Wis-Hipple]

We temperature screen staff. Right by the entrance to the hospital. My corner of the world it has been chilly. Every single day my temp has been below 30 degrees Celsius.


Sent from my iPhone using SDN mobile

Very sensitive test

 

[OTCAwesome]

At my hospital electives have resumed. All patients are being tested for covid the day before. Urgent cases tested and surgery delayed until results.

Same here too, I was on our covid intubation and line team (thanks ASA), just dissolved it as of today, considering going to one of those any lab now places to get the serology test to see if I'm "immune", I'm a young guy and otherwise healthy, my concern this whole time has been exposing my wife an I's parents who are older.

 

[BLADEMDA]

We have wealthy areas of town where the prevalence is 30/100000 and another area 10 miles away where it is >300/100000. We draw patients from all those areas. We test all patients but are not testing or even temperature screening staff. Agree that it’s a joke.

1. All staff should be tested. We are a high risk group for spreading the disease (asymptomatic super spreader)
2. Every day temperature should be checked- All staff and patients
3. Covid 19 screening- At some point Covid screening prior to surgery should be routine. But, if your prevalence is "low" like less than 150 or 100 or 80 then you could follow the cases in your area/county. I suspect that the cases will start to increase over the next 2 weeks so even if you decide not to test for Covid 19 now you will need to soon. As the positive rate rises screening will be required and not just recommended.
4. Serology testing- Consider adding serology testing for antibodies to Covid 19 for staff members as that test becomes more available.

Any facility that isn't screening their staff properly is exposing patients to unnecessary risk.

 

[drmwvr]

1. All staff should be tested. We are a high risk group for spreading the disease (asymptomatic super spreader)
2. Every day temperature should be checked- All staff and patients
3. Covid 19 screening- At some point Covid screening prior to surgery should be routine. But, if your prevalence is "low" like less than 150 or 100 or 80 then you could follow the cases in your area/county. I suspect that the cases will start to increase over the next 2 weeks so even if you decide not to test for Covid 19 now you will need to soon. As the positive rate rises screening will be required and not just recommended.
4. Serology testing- Consider adding serology testing for antibodies to Covid 19 for staff members as that test becomes more available.

Any facility that isn't screening their staff properly is exposing patients to unnecessary risk.

My system is blissfully 'whistling past the graveyard' in avoiding this question. On the one hand they'd of course send home every asymptomatic positive screened staff member on the other they know the potential for decimating staff numbers. Part of the calculus, I'm sure, is that robust hygenic practices and masks will mitigate asymptomatic spread in the hospital.