How Hospitals Are Managing a Backlog of Elective Surgeries From COVID-19

As the influx of COVID-19 patients decreases in some parts of the country, many healthcare facilities have been able to resume elective surgeries. But getting a procedure scheduled or re-scheduled could take some time. A study published on May 12 in The Journal of Bone and Joint Surgery projects that it may take 7 to 16 months for the healthcare system to perform 90% of the elective surgeries that were scheduled pre-pandemic. 

This backlog may affect you or a loved one who has had an elective surgery postponed. Depending on where you live, you may need to prepare for the possibility of further delay, since states like Georgia and California are experiencing a resurgence of COVID-19 cases.

How Elective Surgeries Are Prioritized

In general, hospitals rank surgeries according to the urgency of a patient’s health condition. 

“We have been carefully prioritizing patients based on the severity of their symptoms and condition,” Conor Delaney, MD, PhD, a colorectal surgeon and Chairman of the Cleveland Clinic’s Digestive Disease and Surgery Institute, tells Verywell. 

The American College of Surgeons is referencing St. Louis University's Elective Surgery Acuity Scale (ESAS) for guidance on ranking surgeries. The scale says that high-acuity surgeries—meaning surgeries that require more intense care and intervention—should still be performed on schedule and in a hospital. Low-acuity surgeries, like for carpal tunnel syndrome, can be postponed or performed in an ambulatory surgery center (ASC).

“ASCs are outpatient facilities that allow patients to be discharged home on the same day,” Paul MacKoul, MD, GYN, co-founder of The Center for Innovative GYN Care in Rockville, Maryland, tells Verywell. He adds that some advanced surgeries, such as hysterectomies, may be performed at an ASC. 

Some surgeries are not elective, but rather essential. For example, doctors have performed surgeries for heart disease, abdominal emergencies (e.g., appendectomy), and physical trauma throughout the pandemic.

“Essential surgeries are life-saving," Delaney, who is also a professor of surgery, says. "They preserve the function of organs and limbs, reduce the progression of disease, or reduce the risk of severe symptoms."

Your Location Can Impact the Backlog

Whether elective surgeries are back on track depends largely on the community and facility resources in your area. If more people with COVID-19 are admitted into the hospital, a shortage of resources—staff, patient beds, and equipment—can cause a delay in elective surgeries. In fact, on June 25, Governor Greg Abbott of Texas ordered hospitals to stop elective surgeries in four counties in response to rising COVID-19 cases.

MacKoul says elective surgeries are still behind schedule in Maryland.

“The hospitals are backlogged and it’s difficult for the physicians who use hospitals to perform surgeries,” he says. ASCs, on the other hand, are “up and running, increasing their volume.” 

According to Delaney, the Cleveland Clinic—which is in Ohio—is increasing elective surgeries.

“We’re almost back to a [pre-pandemic] surgical volume for many services,” he says. An exception is orthopedic surgery. But Delaney attributes the delay to patients' hesitation to come into the hospital rather than a lack of resources.

Undergoing Elective Surgery During COVID-19

It’s understandable to be nervous about contracting COVID-19 in a healthcare facility treating patients with the disease. Delaney shares a few safety guidelines Cleveland Clinic has in place for both patients and staff:  

• Face masks are required.
• Physical distancing is required in waiting rooms, at check-in, and in doctor’s offices.
• Visitors are limited and screened for potential COVID-19 symptoms.
• All patients are tested for COVID-19 before their surgery, whether inpatient or outpatient.
• When necessary, such as in the emergency room, rapid COVID-19 (results in 15 minutes or less) testing is administered.

MacKoul says performing an elective surgery in an ASC, if possible, can help limit exposure to COVID-19. The smaller space has fewer healthcare employees and can be more easily disinfected.

Like hospitals, ASCs also require COVID-19 testing in advance of the procedure—usually four days before, according to MacKoul.

What To Do If Your Surgery Is Postponed 

While waiting for your re-scheduled surgery, it’s important to maintain regular communication with your doctor, who may provide medical care through telehealth.

“Telehealth can help the patient and provider decide whether an office visit is needed to further evaluate the patient’s condition, symptoms, and the necessary next steps,” Delaney says.

While telehealth can be useful for managing a condition at home, it cannot replace in-person medical care if your condition worsens. Talk to your doctor about knowing when to visit an emergency room for further evaluation if necessary.

Don’t Postpone Your Surgery Without Speaking With Your Doctor 

Because of fears of contracting COVID-19, some people avoid going to the doctor or a healthcare facility for medical attention. This delay in seeking care can have harmful consequences.

“Progression of a disease can lead to long-term problems and ultimately more complex surgical procedures which can lead to increased complications, much longer recovery time, and pain,” MacKoul says. 

Your doctor can explain the risks associated with delaying versus having the procedure, as well as any other type of care that could be appropriate in the meantime. Together, you and your doctor can determine the best course of action. 

“We know that many patients who would have come for routine care during this period have deferred that care," Delaney says. "It’s possible that if everyone starts to come looking for care in the fall that some healthcare systems will not have enough access."

Therefore, it’s in your best interest, Delaney says, to try to get treated as soon as possible.

A Word From Verywell 

Having your surgery postponed can be inconvenient and frustrating. With each state reopening at its own pace and some experiencing an increase in COVID-19 cases, it’s difficult to tell how fast it will take the healthcare system to get back on track with elective surgeries. In the meanwhile, keep in touch with your doctor to monitor your condition.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.