All but most urgent surgery cancelled due to COVID-19

Public Health

By Mardi Chapman

25 Mar 2020

It’s not every day that medical colleges get such a quick and positive government response to their requests ​- but the COVID-19 pandemic means these aren’t ordinary days.

Within hours of the Royal Australasian College of Surgeons (RACS), College of Anaesthetists (ANZCA), College of Obstetricians and Gynaecologists (RANZCOG) and College of Ophthalmologists (RANZCO) issuing a call to halt all but the most urgent elective surgery, they found the Prime Minister was right there with them.

In a coronavirus update from Parliament House today, Prime Minister Scott Morrison said all elective surgery other than Category 1 and urgent Category 2 cases will be suspended.  

“Cancellation of elective surgery will allow the preservation of resources, including PPE, and allow health services, public and private, to prepare for their role in the COVID-19 outbbreak,” the Prime Minister said. 

The ban goes into effect from midnight Wednesday March 25.

Colorectal Surgical Society of Australia and New Zealand (CSSANZ) president Dr Damien Petersen said his colleagues were already limiting elective procedures such as colonoscopy unless it was considered urgent or there was a high chance of finding a cancer.

“And even after what Scott Morrison has said, I think that would still fit into Cat 1 or urgent Cat 2. Obviously a routine colonoscopy can be deferred for 6 months,” Dr Petersen said.

“With respect to surgery, cancer is Cat 1 so we are still permitted to do that but as a group we’re already questioning whether there are other alternatives to surgery for some of these patients.”

“And especially if you are doing fairly risky procedures, we’ve really got to consider whether that is the right thing to do at the moment considering they do take a lot of resources and they might be in hospital for weeks at a time.”

“Where possible, maybe we could defer people and give them alternative treatment such as chemo but obviously not all tumors are chemo-sensitive and so we have to make individualised decisions.”

He said similar rules would also apply in urgent Cat 2 patients where a significant painful condition might worsen without surgical treatment.

President of the Australian Knee Society Associate Professor Chris Vertullo told the limbic that 99% of surgeons were basically coming to the same decision. 

“I basically had started cancelling everything anyway.  For me, all the joint replacements I had are off, which is the right decision. I think everybody I’ve spoken to is very happy.”

He said there were no capacity constraints yet at Gold Coast hospitals.

“But I’m in total agreement that there is an inadvertent risk to colleagues and other patients due to asymptomatic patients infecting others through aerosolisation of virus particles. It’s a good thing that they have done this. It’s an excellent decision,” he said. 

The RACS, ANZCA, RANZCOG and RANZCO presidents had said that continuing non-emergency elective surgery was unnecessarily putting patients and staff at risk of infection with the coronavirus.

“There must be a consistent national approach, which prioritises the health, safety and wellbeing of all patients and medical staff, given the dramatic escalation in COVID-19 cases. All non-urgent elective surgery in public hospitals should be cancelled. Private hospitals should be mobilised to accept urgent surgery,” said RACS president Dr Tony Sparnon.  

ANZCA president Dr Rod Mitchell also warned that “the continuation of elective surgery is consuming vital reserves of medicines and other important hospital resources. It is also reducing the time available for doctors and nurses to prepare for the management of the expected large numbers of critically ill patients.”

“Personal protective equipment is already in critical short supply and must be conserved. This is essential to secure the safety of our health workforce,” he said.

RANZCOG president Dr Vijay Roach called for critical gynaecological procedures, including abortion, and all care during birth, including caesarean sections, to continue as usual.

RANZCO President Associate Professor Heather Mack said urgent, sight-preserving, eye surgery needs to continue.

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