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Clinical Updates

Many Patients Fear Returning to Surgery in COVID-19 Era. New ACS Patient & Surgeon Resources Can Guide Communication to Help Restore Confidence

As health care facilities resume operations that were paused during the COVID-19 pandemic, a new survey shows many patients are fearful of undergoing procedures and may not reschedule necessary care while COVID-19 continues to circulate in communities. To help surgeons and hospitals address patient concerns, the American College of Surgeons (ACS) has released a new resource, Preparing to Have Surgery during the Time of COVID-19.

The document includes a discussion guide with suggested questions patients may ask their surgeon to feel more prepared for their procedure. The guide also covers common concerns such as how the check-in process has changed, what to expect during appointments, safeguards to prevent the spread of COVID-19, and how the ongoing pandemic may change postoperative care.

New research found that more than one-third of patients would feel uncomfortable returning to care until at least three months after COVID-19 restrictions are lifted in their area, and one in five would feel discomfort for six months. Having frank and open discussions with their surgeons may ease patient concerns about returning for care to avoid further complications if procedures are delayed.

The ACS also has created a companion worksheet to help surgeons prepare answers to anticipated patient questions and enlist members of the patient’s care team and facility’s administration as part of the preparation process.

“Pausing most operations helped hospitals prepare to treat patients with COVID-19 and secure necessary equipment,” said David B. Hoyt, MD, FACS, ACS Executive Director. “With the right protocols in place, many hospitals can now begin to resume operations to avoid further delays that can impact patient outcomes. For patients to feel comfortable returning, they need to clearly understand the safety measures hospitals have put in to place and how the care experience will be different now than it was before the pandemic.”

The new resources complement the hospital guidance document the ACS released April 17.

New Pediatric Surgery Scoring Scale to Help Surgeons Prioritize Operations

In response to evidence suggesting that COVID-19 may affect children differently than adults, pediatric surgeons at the University of Chicago (UChicago), IL, have modified an evaluation instrument for use in pediatric patients, which allows surgeons to prioritize nonemergency operations during the pandemic. The new pediatric-specific scoring system is presented as an article in press on the Journal of the American College of Surgeons (JACS) website.

The Pediatric Medically Necessary Time-Sensitive (pMeNTS) scoring system adapts the adult MeNTS approach, which pediatric surgeons at UChicago Medicine found needed to be revised to deliver optimal pediatric surgical care, according to Mark B. Slidell, MD, MPH, FACS, the lead investigator and associate professor of surgery at UChicago Medicine. Among the differences is that many children who test positive for COVID-19 appear asymptomatic. In addition, recent reports noted a new serious complication of COVID-19 in some infected children: an inflammatory syndrome that can negatively affect multiple organs.

Dr. Slidell’s coauthor, Grace Z. Mak, MD, FACS, UChicago Medicine associate professor of pediatrics and surgery, said users of the pMeNTS scoring worksheet can update it to include new COVID-19 developments.

As the pandemic changes the concept of elective operations, pMeNTS focuses on an operation’s medical necessity and time sensitivity. It also assesses infection risk for the patient and providers as well as projected use of hospital resources, including protective gear, beds, blood products, and staffing. The tool, which Dr. Slidell emphasizes is not a risk calculator, systematically evaluates factors related to the procedure, the patient’s disease, and the patient’s individual risks. Users rate each factor on a five-point scale and total the scores. A lower overall pMeNTS score indicates a more favorable surgical risk, less risk to personnel, and less resource utilization and can be used to determine a higher priority for the procedure.

The hospital’s surgical department leaders review the assigned scores for each surgical case and can shift the scoring cutoff each day for high-priority operations based on available resources, Dr. Mak stated. Unlike the adult scoring system, pMeNTS accounts for chronic childhood diseases and birth anomalies, such as prematurity or congenital heart and lung diseases that may raise susceptibility to more severe COVID-19 infection.

National Survey of Surgical Residents Shows Bullying Is Frequent and Associated with Burnout

Nearly 67 percent of respondents to a recent survey of U.S. general surgery residents reported experiencing at least one bullying behavior as a surgical resident, and 18 percent reported being the subject of frequent bullying. The survey, which was administered electronically to U.S. general surgery residents following the 2019 American Board of Surgery In-Service Training Examination, was published online May 26 in the Journal of the American Medical Association (JAMA). The research team included health care professionals at the Surgical Outcomes and Quality Improvement Center (SOQIC) at Northwestern University and the American College of Surgeons (ACS), Chicago, IL.

The survey findings reveal that frequent bullying often originates with attending surgeons and other surgical residents. The researchers concluded that interventions should focus on surgeon professionalism. The first author of the study, Lindsey M. Zhang, MD, ACS Clinical Scholar in Residence, noted, “Women were more frequently bullied, and training in a program with more women or with departmental leaders who were women was not associated with decreased bullying.” However, she added, “The wide variability in program-level bullying rates suggests that surgical training can occur without bullying.”

“We continue to focus on how to improve surgical training, and this is one area that has long been perceived to be an issue in surgery,” said Karl Bilimoria, MD, MS, FACS, ACS Faculty Scholar and director, SOQIC. “By bringing data and science to the issue, we can begin to address bullying in surgical training head on.”

The survey findings build on data from a previous survey reported on at the ACS Clinical Congress 2019 and published in the New England Journal of Medicine (NEJM), which found general surgery residents who often experience mistreatment during residency training are at greater risk of burnout and suicidal thoughts. The data from these surveys support the need for the SECOND Trial, also known as Surgical Education Culture Optimization through targeted interventions based on National comparative Data.