Demand for Surgical Procedures Following COVID-19: The Need for Operational Strategies That Optimize Resource Utilization and Value

The Need for Operational Strategies That Optimize Resource Utilization and Value

Nicholas L. Berlin, MD, MPH; Justin B. Dimick, MD, MPH; Eve A. Kerr, MD; Ted A. Skolarus, MD, MPH; Lesly A. Dossett, MD, MPH


Annals of Surgery. 2020;272(4):e272-e274. 

In This Article

Abstract and Introduction


Throughout the United States, health system capacity may be overwhelmed by the medical care necessary to treat patients with coronavirus disease 2019 (COVID-19). To prepare for this surge in medical demand, health systems have been forced to rapidly prioritize and adapt clinical care delivery.[1] A key strategy in building inpatient capacity has been to cancel or temporarily delay nonessential elective surgery and procedures to provide critical equipment, space, providers, and staff for critically ill medical patients.[2,3] To date, most attention related to COVID-19 has been appropriately focused on the acute challenges facing health systems and providers. However, as health systems move beyond their local surge of COVID-19 cases, they will also face novel challenges in accommodating a pent-up demand for surgical and procedural care (Figure 1). Operational strategies that optimize resource utilization and promote value will be essential to safely and ethically address the unique challenges posed by a post-COVID-19 surgical backlog.

Figure 1.

Conceptual model of deferred demand for surgical procedures following COVID-19.

How health systems and surgeons plan to address this increased demand during the ramp-up period has important implications for patient satisfaction and clinical outcomes. A poorly coordinated ramp-up of surgical care may contribute to further progression of underlying disease processes and worsen established disparities in both access to care and patient outcomes.[4,5] Cancer patients, and many others in whom time-sensitive surgical treatment has been delayed, will need to quickly be placed back on the operating room (OR) schedule. For instance, women with estrogen receptor-positive breast cancer have already faced delayed definitive surgical management in favor of nonoperative, less well-supported treatment recommendations.[6,7] Therefore, it is critical that we understand the resources necessary to meet pent up demand to effectively prioritize critical cases. The typical first-come, first-serve, fee-for-service paradigm of managing perioperative and OR capacity would be insufficient, and potentially inappropriate, to provide care for postponed and new patients, as well as tending to the safety of our providers and staff in the months following the pandemic.