Hospitals resume elective surgeries
Emergency surge hasn’t arrived — processing backlog may take months
At least one Bay Area hospital is already performing and scheduling nonemergency surgeries — postponed during California’s shelterinplace order — as the state takes the first tentative steps toward reopening.
Even before Gov. Gavin Newsom announced Wednesday that hospitals could begin to schedule some elective surgeries for the first time in more than a month, UCSF has been getting such surgeries on the calendar for the past two weeks, including replacing kidneys and conducting certain heart surgeries and cancer procedures — all of which have been deemed nonemergency during the pandemic.
One of the first in line, on April 13, was San Jose resident Rosemary PathyMcKinney, who had a nonmalignant brain tumor that clouded her vision and gave her headaches. She’s recovering after the tumor was removed, but is still waiting to schedule radiation for another inoperable tumor.
UCSF made this and other decisions to operate “with counseling from the surgeon, and discussion with the patient with the risks of waiting versus going ahead,” surgeon Dr. John Roberts said.
Like other hospitals throughout the state, UCSF postponed hundreds of medically necessary but nonemergency surgeries — up to 60 a day since midMarch. The hospital conducted only lifesaving procedures classified by the Centers for Medicare & Medicaid Services as top priority.
But in the last couple of weeks, with plenty of beds available and low coronavirus case numbers, the hospital also set up five to 10 lowerpriority surgeries each day, including replacing kidneys and repairing arteries.
Because California isn’t seing a COVID19 case surge, Newsom announced at his daily coronavirus briefing Wednesday that many patients should no longer have to wait to get care.
“If it’s delayed, it becomes acute. It fundamentally is a health issue,” he said.
UCSF may now also begin rescheduling the lowestpriority operations, such as knee and hip replacements, Roberts said. Those procedures wouldn’t start until midMay.
Surgeons must balance individual medical needs with whether the hospital has enough bed space, staff and personal protective equipment to keep patients and workers safe from COVID19, said California Hospital Association President Carmela Coyle. Hospitals also have to keep caring for coronavirus patients and prepare for a potential surge.
Although COVID19 hospitalizations in California decreased Thursday, the state recorded its deadliest day, with more than 100 fatalities, Wednesday.
“Surgery isn’t like a valve you can turn on and all of a sudden start doing surgeries,” said Roberts of UCSF. Even with restarting, it will take the hospital 40 weeks to get through the backlog, he added.
Other hospitals are also crafting plans to restart operations. Sutter Health postponed joint replacements, spine surgeries, some gynecologic surgery, heart operations that could be safely postponed and cosmetic surgery except for reconstruction, a spokeswoman said. Sutter and another major hospital system, Kaiser Permanente, declined to say when nonemergency surgeries would resume, but said they would be in touch with patients soon.
For all, “the bottom line to reopening is safety,” said Coyle of the hospital association.
Hospitals have never stopped performing lifeordeath procedures, from cancerous tumors to organ transplants and heart surgery, even after California imposed shelterinplace orders on March 19 — or two days earlier in much of the Bay Area.
Although Newsom didn’t provide a list of permissible nonemergency procedures that could resume, he gave some examples: replacing heart valves, removing tumors and performing such preventative care as colonoscopies.
Kaiser Permanente is looking forward to resuming nonurgent and elective procedures “as soon as possible,” Dr. Stephen Parodi, associate executive director of the Permanente Medical Group, said.
The vast majority of procedures at Kaiser since midMarch have been for urgent conditions like cancer care, Parodi said, adding that others were done “after a thorough risk and benefit discussion with each patient.”
Doctors have been following up with patients whose procedures were delayed. As the hospital system looks to reschedule some elective surgeries, doctors are trying to prioritize among those with delayed procedures.
“We fully understand our patients’ anxiety and concerns regarding elective surgery during this unusual time,” Parodi said. “We know that every procedure that has been considered nonurgent or elective during this pandemic is of great importance to the patient waiting for it.”
Sutter Health officials were more reluctant to say when surgeries would resume.
“Surge readiness remains our top clinical priority,” said Dr. Bill Isenberg, chief quality and safety officer.
“We will resume services with a phased, safetyfirst approach,” he said. “We know patients are eager to reschedule deferred procedures and care, and we want them to know that we are here to care for them.”
Whether to reschedule a procedure is up to surgeons and their patients, Roberts said, noting that some may decide they don’t want to come to the hospital if it means potential exposure to COVID19. Hospitals may also continue banning visitors, he said, which could also deter some people from getting nonessential surgery. But other patients and doctors are eager to restart, he added.
“Hospitals are incentivized to have this happen. They want to do it, and their doctors want to do it too. I think it will happen as soon as possible,” said Dr. Peter Alperin, a San Francisco primary care physician affiliated with California Pacific Medical Center and other hospitals.
Alperin recently sent one of his patients with extreme abdominal pain to surgery but delayed another with a knee replacement because it wasn’t an emergency.
“Patient anxiety is real, and it’s negative, and we want to do everything we can to alleviate it,” he said.