Returning to Elective Orthopedic Surgery During the COVID-19 Pandemic: A Multidisciplinary and Pragmatic Strategy for Initial Patient Selection

Objective The aim of the study was to design an objective, transparent, pragmatic, and flexible workflow to assist with patient selection during the initial phase of return to elective orthopedic surgery during the COVID-19 pandemic with the main purpose of enhancing patient safety Methods A multidisciplinary working group was formed consisting of representatives for orthopedics, epidemiology, ethics, infectious diseases, cardiovascular diseases, and intensive care medicine Preparation for upcoming meetings consisted of reading up on literature and testing of proposed methodologies on our own waiting lists Results A workflow based on 3 domains, that is, required resources, patient fitness, and time sensitivity of the procedure, was considered most useful All domains function as standalones, in a specific order, and no sum score is used The domain of required resources demands input from the surgical team, results in a categorical (yes or no) outcome, and generates a list of potential patients who can be scheduled for surgery under these particular circumstances The (weighted) items for the domain of patient fitness are the same for every patient, are scored on a numerical scale, but are likely to change during the pandemic as more data become available Time sensitivity of the procedure is again scored on a numerical scale and becomes increasingly important when returning to elective surgery proves to be acceptably safe After patient selection, an augmented informed consent, screening, and testing according to local guidelines will take place Conclusions A workflow is proposed for patient selection aiming for the safest possible return to elective orthopedic surgery during the COVID-19 pandemic Correspondence: Georges F Vles, Division of Orthopaedic Surgery, University Hospitals Leuven, Gasthuisberg Herestraat 49, 3000 Belgium (e-mail: orthopedie@uzleuven be) W O is a proctor for Medtronic regarding minimally invasive multivessel coronary artery bypass grafting L M is a consultant for Medtronic The other authors disclose no conflict of interest G V and S G contributed equally and are therefore joint first author This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4 0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited The work cannot be changed in any way or used commercially without permission from the journal This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections Copyright © 2020 Wolters Kluwer Health, Inc All rights reserved