MAKING THE CALL The pandemic has forced surgeons to decide when a patient's condition requires immediate action.

The coronavirus continues to spread across the nation with infection rates expected to peak over the coming weeks. As part of the national response to the ongoing crisis, surgeons are being asked to curtail elective surgeries in order to preserve personal protective equipment and healthcare resources for the care of critically ill patients. The directive has left some surgeons questioning when they should call off a case and when it's best to proceed as planned.

The American College of Surgeons (ACS) hopes to clear up the confusion with a new clinical guidance document for elective surgical case triage. The surgical decision-making document builds on guidance ACS issued last week that advised surgeons to postpone or cancel nonemergent procedures. ACS says its new document, which was developed following review by experts in several specialties, provides the "most current best evidence available" for a wide variety of elective surgeries, including those for various cancers, gynecology, neurosurgery, ophthalmology, orthopedics, otolaryngology and urology.

"[W]e appear to be entering a new phase of the COVID-19 pandemic with more hospitals facing a potential push beyond their resources to care for critically ill patients," says ACS Executive Director David B. Hoyt, MD, FACS. "ACS will continue to monitor the landscape for surgical care, but we feel this guidance document provides a good foundation for surgeons to begin enacting these triage recommendations today to help them make the best decisions possible for their patients."

ACS encourages the document to be used in conjunction with this week's joint statement from ACS, the American Society of Anesthesiologists (ASA) and the Association of periOperative Registered Nurses (AORN) that recommends medical centers establish surgical review committees consisting of leaders from surgery, anesthesiology and nursing. These committees should serve as administrative bodies that provide "defined, transparent, and responsive oversight for triaging surgical cases during the COVID-19 pandemic," say the organizations. They recommend the committees make daily decisions regarding surgical cases, no later than the day before any scheduled surgery. They also issued guidance on how to create such committees, which they said "can lead the development and implementation of guidelines that are fair, transparent, and equitable in consideration of rapidly evolving local and regional issues."

The organizations say they needed to fill gaps in national guidance on these urgent issues.