Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic

• Published in: Journal of clinical anesthesia Vol. 64; p. 109854
• Main Authors: Dexter, Franklin, Elhakim, Mohamed, Loftus, Randy W., Seering, Melinda S., Epstein, Richard H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2020; Elsevier Limited
• Subjects: Ambulatory care; Ambulatory Surgical Procedures; Bacterial infections; Betacoronavirus; Bone surgery; Coronavirus; Coronavirus Infections; Coronaviruses; COVID-19; COVID-19 diagnostic tests; Disease prevention; Disease transmission; Endoscopy; General anesthesia; Humans; Infection Control; Infections; Local anesthesia; Masks; Nose; Operating Rooms; Outpatient care facilities; Pain; Pandemics; Patients; Personal protective equipment; Pneumonia, Viral; Regional anesthesia; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Staphylococcus aureus; United States > US
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2020.109854

We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery.
Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., S. aureus transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons.
Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h).
For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases.
When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned.
In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.
•What are the economic consequences of COVID-19 for ambulatory surgery centers?•For general anesthesia, phase I postanesthesia care in the operating room•For aerosol producing surgery, also full environmental cleaning after each case