Scheduling Your Surgery After the COVID-19 Quarantine

The global COVID-19 pandemic has had an unusual impact on healthcare systems—let alone the economy and your own day-to-day life.

In geographic areas where cases of COVID-19­ have surged, hospitals are pushed to their limits of capacity. Meanwhile, in other areas hospitals are seeing dramatic decreases in admissions and revenue. One Midwest center reported a 30 percent decline since late March.¹

The decline is due to several factors. Social distancing, quarantine, and shelter-in-place orders are keeping people off the roads and at home. Some people are wary about going to the emergency room out of fear of unnecessarily exposing themselves to COVID-19. On top of that, hospitals and outpatient surgical centers have temporarily suspended elective surgeries in order to support social distancing efforts, conserve personal protective equipment (PPE), and free up ventilators, beds, personnel, and supplies that may be needed for the care of COVID-19 patients.

If you or a loved one has had a hip, knee, shoulder, or other type of elective joint replacement surgery postponed due to the COVID-19 pandemic, you may have mixed feelings right now. On the one hand, you're probably still looking forward to the hope of increased function and reduced pain that joint replacement can offer. On the other hand, you may feel concerned about having the procedure during such an interesting time in history. How soon should you re-schedule? What's the right way to proceed with your surgery in order to keep you and your loved ones better protected? Will it be safe to go to the hospital?

Many people have similar concerns. Reportedly, providers, healthcare systems, and governing agencies are working hard to implement measures to help protect patients, visitors, and staff for when the time comes to lift social distancing guidelines and resume elective procedures.

How hospitals and surgeons are planning to resume elective surgeries

Here are a few ways hospitals and providers are preparing for the resumption of elective surgeries once this wave of the pandemic is over:

• Many providers and hospitals are abiding by specific re-opening considerations recently published by the American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, and the American Hospital Association.² Recommended considerations for resuming elective procedures include "a sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days" and enough intensive care unit (ICU) and non-ICU beds, PPE, ventilators, and staff to treat all hospitalized patients (including elective and non-elective patients) without resorting to crisis care.² Feel free to ask your local health providers and public health officials what parameters they're taking into consideration prior to resuming joint replacement surgeries.
• Strict use of PPE, exceptional environmental cleaning protocols, and even social distancing strategies in waiting rooms and common areas are anticipated.
• Worried about backlogs and long wait times? Call your surgeon's office to inquire about getting your name on the schedule ahead of time.

How YOU can prepare for your upcoming joint replacement

Healthcare providers and organizations are doing their part to prepare for the eventual return of elective procedures—and you can, too! Here are a few things to consider during this unusual time of quarantine and social distancing:

• Consider outpatient surgery. Some surgeons offer outpatient joint replacement surgeries for appropriate candidates, often in facilities that are dedicated solely to orthopedic cases. This may be a good option for you if you're hoping to avoid admission to a hospital.

• Ask your surgeon if you’re a candidate for telehealth or other home rehabilitation tools. Many physical therapy and occupational therapy clinics are now offering telehealth visits.³ This allows patients to receive therapy (via video-chat internet services) from the comfort and safety of their own homes. You may choose to consult with a physical therapist or occupational therapist before your surgery in order to maximize your strength, stamina, and overall health. This way, you may be more prepared going into your procedure. Not only can this minimize your pain and boost function now, but some research shows it may even improve your outcomes, cut costs, and reduce the risk of post-operative complications.^4-6 Be sure to speak with your insurance provider to find out if your visits will be covered.

• Take care of your overall health. Managing stress may be easier said than done during a global pandemic, especially if you're living with a chronically painful joint. But stress can worsen pain and increase inflammation, which is known to delay tissue healing.^7-8 Patients are often instructed to prepare for surgery by practicing healthy habits that optimize your physical and mental well-being (e.g., get a good night’s sleep; eat a nutritious diet; exercise daily; avoid excessive alcohol and caffeine; quit smoking; etc.).

Patients awaiting their joint replacement surgery may choose to view these unusual times as an opportunity to buckle down on their healthy habits and maximize their readiness for surgery. Be sure to talk to your doctor or a mental health professional to learn more about how you can make the most out of your time in quarantine.

1. NewsCenter1 Staff (2020, Apr 17). Monument Health to furlough 200 caregivers, 25% pay cut to executives. NewsCenter1. www.newscenter1.tv/monument-health-to-furlough-200-caregivers-25-pay-cut-to-executives/
2. Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic (2020, Apr 19). American College of Surgeons. www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery
3. Telehealth in Physical Therapy in Light of COVID-19 (2020, Apr 14). American Physical Therapy Association. http://www.apta.org/Telehealth/COVID-19/TelehealthDuringCoronavirus/
4. Education from a Physical Therapist Before Back Surgery May Reduce Cost, Improve Outcomes (2020, Apr 21). ChoosePT provided by the American Physical Therapy Association. www.choosept.com/didyouknow/detail/education-from-physical-therapist-before-back-surg
5. Snow, R., et al. (2014, Oct 1). Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement. JBJS. 96(19): 165. journals.lww.com/jbjsjournal/Abstract/2014/10010/Associations_Between_Preoperative_Physical_Therapy.11.aspx
6. American Academy of Orthopaedic Surgeons (2014, Oct 7). Can physical therapy before hip, knee replacement surgery improve outcomes? ScienceDaily. https://www.sciencedaily.com/releases/2014/10/141007111225.htm
7. Stress Effects (2020, Apr 21). The American Institute of Stress. www.stress.org/stress-effects
8. Gouin, JP and Kiecolt-Glaser, J. (2011, Feb). The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms. Immunol Allergy Clin North Am. 31(1): 81–93.   www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/