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Hospitals, docs trying to keep up with elective surgery backlog

Joyce Faber’s elective surgery has been postponed twice so far this year. It’s been rescheduled for September, but she’s worried that the lengthy wait could cause complications.

“My son is graduating with his doctorate in December,” she said in a recent interview. “I’m worried I won’t be able to see him graduate.”

Faber, a resident of Bridgeport, Ohio, has familial spastic paraparesis, a relative of multiple sclerosis, which requires a pump to be implanted in her abdomen to deliver a muscle relaxer medication 24/7. She has to have surgery to get the pump replaced every five and a half years when the battery dies. She was due to have that surgery in April through Cleveland Clinic.

“They called and said, ‘We have to cancel your surgery,'” Faber said.

They canceled because the pump device was out of stock, she said. They rescheduled for the end of July, but recently postponed that one as well. Apparently, the manufacturing company came out with a new model of the device, which has not yet been approved by the Food and Drug Administration.

Faber has questioned whether the pandemic had something to do with the hold ups — if the device manufacturing facility was temporarily shut down or its transportation wasn’t permitted during the pandemic.

“I can’t say this is 100 percent a result of the pandemic, but I’ve never had a problem before at all,” Faber said. “It’s the fifth surgery I’ve had relating to this pump.”

She’s battled kidney and breast cancer, and this was to be her 20th surgery.

September will be the six year mark since the last pump was implanted, she said, and they have a six-year battery life. The battery alarm sounds on the device, notifying when there are 24 hours of medication left, she said.

“If the device stops working, I won’t be able to bend my legs at all,” Faber said.

It would mean a much more complicated surgery for Faber, one she’s been through twice now.

“I’m 60,” she said. “I don’t know that I can go through it again. It’s putting me and my health and my life in a pretty risky place.”

Faber is one of thousands of Americans who have had elective surgeries or procedures postponed during the pandemic for one reason or another. Medical facilities across the nation have been working since May to decrease a backlog of patients whose operations were postponed or canceled in the spring.

At Ruby Memorial Hospital in Morgantown, W.Va., Dr. Judie Charlton, the chief medical officer of WVU Medicine, said they’re still working through that backlog.

“We’re no longer putting off cases that could wait,” Charlton said.

They extended their hours during the week and opened up for elective operations on the weekends, too, in order to be able to take care of more patients. They also had a group of physicians prioritizing that backlog to determine which patients needed to be seen first.

“They would submit their highest priority cases, and the group would sort through the circumstances and essentially rank them,” Charlton said. “We had to only do urgent cases, mostly because of the PPE. The more difficult ones were cancer.”

Because some cancers progress very quickly, those are the ones they had to prioritize over a cancer diagnosis that develops slowly, Charlton said.

“So, we’d put aside the slow-growing cancer patients,” she said. “But who wants to be home knowing they have a cancer diagnosis, and they’re not doing anything about it? Those were hard ones.”

Other health networks, like Cleveland Clinics and the Allegheny Health Network, said their systems are big enough and that they had enough room and staff to avoid those types of difficult decisions.

“I think we were lucky in the size of our system,” said Dr. Conor Delaney, chairman of the Digestive Disease and Surgery Institute at Cleveland Clinic. “We had a buffer of hospital beds and ICU beds.”

Dr. Sri Chalikonda, chief officer of medical operations at AHN, said that systemwide, they had a backlog of about 3,000 cases that needed to be rescheduled due to the state shutdown. Since being allowed by the state to continue those procedures, each of those patients “has been seen or offered surgery,” he said.

“We did not hold on any procedure that met the definition of urgent or potentially life-threatening,” Chalikonda said. “We had to be very, very efficient to get through our backlog.”

Kelly Ankrom, executive director at the Tri-State Surgery Center headquartered in Washington County, Pennsylvania, said she had surgeons and physicians calling her facility desperate to get patients in for operations during the shutdown.

“We have seen patients and doctors literally begging to get in during the six weeks we were shut down,” she said. “We were trying to follow the limited guidance from the CDC, while physicians were pleading the case for a patient who was in pain.”

Her facility typically schedules 600 cases a month, but in April, doctors only did 74 procedures that were considered urgent. The majority of the staff was laid off during that time.

“On a positive note, July has proven to pick back up,” Ankrom said. “Patients are excited to be getting their cases done. Everybody’s safety is our number one priority.”

Delaney said the Cleveland Clinic coordinated much of its elective operations with the state’s regulations, most of which were lifted by June, while also keeping an eye on how much personal protective equipment they have along with ensuring they have enough staff, caregivers and beds.

“We are now safely open for caring for patients, but there’s some things we’re watching very closely,” he said.

They’ve since made it through their backlog of patients, Delaney said. The way they prioritized them had to do with diagnosis and symptoms — through four pieces of criteria, including a threat to a patient’s life, the threat of permanent dysfunction of an extremity or organ, the progression of cancer, and rapidly worsening or severe symptoms.

“Anyone who comes in and gets something taken care of, they’re going to be relieved,” Delaney said. “There’s also been a lot of fear. That’s why we’ve been trying to send the message that it is safe to come in and have care. Deferring care is generally not a good thing.”

That fear comes with different reasons, according to Charlton. She said Ruby Memorial would reach out to patients to reschedule their operation, but some didn’t want to go through with it.

“Some patients had a false perception that they would catch COVID-19 at the hospital,” Charlton said.

For others, it was the “no visitor” policies that made them decide to continue to postpone operations.

“There were patients that said they didn’t want to have the surgery without being able to have their loved one be the last person they see before they’re put under anesthesia,” Charlton said.

With the unemployment rate climbing, many patients chose to not have their operations because of either employment insecurity or because they lost their job and any health insurance that came with it.

“That’s one of my biggest concerns — the social side of this pandemic,” Delaney said. “We’ve seen patients changing insurance. Our goal is to take care of the patient.”

Chalikonda said AHN has also had patients put off procedures because they lost their jobs and health coverage.

“If there are people who lost their jobs, sometimes they’re waiting for a new employment status,” he said. “We’re making sure that’s not a barrier.”

While still trying to get all their patients in, Charlton said Ruby Memorial’s efficiency was also challenged, as the preparation for each procedure, the safety measures and the sanitization methods are all much more time-consuming now.

“It’s a more involved process than what it was pre-COVID-19,” she said. “Being safe and cautious takes time. It’s a balancing act because we have patients who need care, and we have to provide it quickly and safely. It’s a good challenge to take on.”

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