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Hospitals try to shrink surgery backlog

Medical centers look to reschedule elective surgeries postponed by COVID

oyce Faber’s elective surgery has been postponed twice so far this year. It’s been rescheduled for September, but she’s worried the lengthy wait could cause complications.

“My son is graduating with his doctorate in December,” she said in a recent interview. “I’m worried I won’t be able to see him graduate.”

Faber, a resident of Bridgeport, has familial spastic paraparesis, a relative of multiple sclerosis, which requires a pump to be implanted in her abdomen to deliver a muscle relaxer medication 24/7. She has to have surgery to get the pump replaced every five-and-a-half years when the battery dies. She was due to have that surgery in April through Cleveland Clinic.

“They called and said, ‘We have to cancel your surgery,'” Faber said.

They canceled because the pump device was out of stock, she said. They rescheduled for the end of July, but recently postponed that one as well. Apparently, the manufacturing company came out with a new model of the device, which has not yet been approved by the Food and Drug Administration.

Faber has questioned whether the pandemic had something to do with the hold ups — if the device manufacturing facility was temporarily shut down or its transportation wasn’t permitted during the pandemic.

“I can’t say this is 100 percent a result of the pandemic, but I’ve never had a problem before at all,” Faber said. “It’s the fifth surgery I’ve had relating to this pump.”

If the device stops working, it would mean a much more complicated surgery for Faber.

“I’m 60,” she said. “I don’t know that I can go through it again. It’s putting me and my health and my life in a pretty risky place.”

Faber is one of thousands of Americans who have had elective surgeries or procedures postponed during the pandemic for one reason or another. Medical facilities across the nation have been working since May to decrease a backlog of patients whose operations were postponed or canceled in the spring.

LOCALLY

Dr. Thomas Jones, president of the medical staff and chief of surgery at Trumbull Regional Medical Center, a Steward hospital, said patients being scheduled for elective surgery there are screened following Centers for Disease Control and Prevention guidelines the day before and day of surgery.

He said elective surgical patients that do not meet screening criteria, are symptomatic, or have had a potential COVID-19 exposure will be postponed.

As part of its “Safe and Ready” program, Trumbull Regional is taking additional, necessary preparations to ensure patients can receive high-quality, compassionate care in a safe, carefully managed environment — without fear of infection, he said.

Trumbull is adhering to a five-point standard ensuring patient safety, and any COVID-19 related care will take place in designated areas on dedicated floors away from other patients and their families, Jones said.

Dr. James Kravec, chief clinical officer for Mercy Health Youngstown, said since early May, elective surgeries have started being done again after two months of them being halted due to the number of coronavirus hospitalization cases.

“We are making sure those patients have their surgeries they have waited for in a safe environment,” Kravec said.

Earlier during the pandemic, only emergency surgeries were being done and elective surgery patients were either postponed by the patient or the hospital at St.Elizabeth hospitals in Boardman and Youngstown and St. Joseph Warren Hospital.

“It is a balance of taking care of the patient for their surgery and keeping them safe,” Kravec said.

BACKLOG

Health networks such as Cleveland Clinics and the Allegheny Health Network said their systems are big enough and they had enough room and staff to avoid those types of difficult decisions.

“I think we were lucky in the size of our system,” said Dr. Conor Delaney, chairman of the Digestive Disease and Surgery Institute at Cleveland Clinic. “We had a buffer of hospital beds and ICU beds.”

Dr. Sri Chalikonda, chief officer of medical operations at AHN, said that systemwide, they had a backlog of about 3,000 cases that needed to be rescheduled due to the state shutdown. Since being allowed by the state to continue those procedures, each of those patients “has been seen or offered surgery,” he said.

“We did not hold on any procedure that met the definition of urgent or potentially life-threatening,” Chalikonda said. “We had to be very, very efficient to get through our backlog.”

Delaney said the Cleveland Clinic coordinated much of its elective operations with the state’s regulations, most of which were lifted by June, while also keeping an eye on how much personal protective equipment they have along with ensuring they have enough staff, caregivers and beds.

“We are now safely open for caring for patients, but there’s some things we’re watching very closely,” he said.

They’ve since made it through their backlog of patients, Delaney said. The way they prioritized them had to do with diagnosis and symptoms — through four pieces of criteria, including a threat to a patient’s life, the threat of permanent dysfunction of an extremity or organ, the progression of cancer, and rapidly worsening or severe symptoms.

“Anyone who comes in and gets something taken care of, they’re going to be relieved,” Delaney said. “There’s also been a lot of fear. That’s why we’ve been trying to send the message that it is safe to come in and have care. Deferring care is generally not a good thing.”

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