OBJECTIVE: The COVID-19 pandemic has resulted in a marked increase in hospital utilization, medical resource scarcity and rationing of surgical procedures. This has created a need for strategies to triage surgical patients. Here, we describe our experience using the American College of Surgeons (ACS) COVID-19 Guidelines for Triage of Vascular Surgery Patients in an academic surgery practice. METHODS: We used the ACS Guidelines as a framework to direct the triage of vascular surgery patients during the COVID-19 pandemic. We retrospectively analyzed the results of this triage during the first month of surgical restriction at our hospital. Patients undergoing surgery were identified by reviewing the operating room schedule. We reviewed the electronic medical record (EMR) and assigned an ACS Category, Condition and Tier Class to each completed surgery. Surgeries that were postponed during that same time period were identified from a prospectively maintained list. We reviewed the EMR for all postponed surgeries and assigned an ACS Category, Condition and Tier Class to each surgery. We reviewed the EMR for all postponed procedures to identify adverse events related to the treatment delay. RESULTS: We performed 69 surgeries in 52 patients during the study period. All surgeries were performed to treat emergent, urgent or time-sensitive elective diagnoses. Forty-seven surgeries (68%) were from Tier 3 and 22 (32%) were from Tier 2b. We did not perform any surgeries from Tier 1 or 2a. We postponed surgery in 66 patients during the same time period. Thirty-six (55%) were from Tier 1, 22 (33%) were from Tier 2a, 5 (8%) were from Tier 2b and 3 (5%) could not be assigned a Tier Class. No Tier 3 surgeries were postponed. Three patients (4.5%) experienced an adverse event that could be attributed to the treatment delay. CONCLUSIONS: The ACS Triage Guidelines provided an effective method to decrease vascular surgical volumes during the COVID-19 pandemic without an increase in patient morbidity. The clinical utility of the Guidelines would be strengthened by incorporating the SURGCON/VASCCON threat level alert system.
Vascular Surgery Triage During the COVID-19 Pandemic