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North Carolina Chapter of the
American College of Surgeons

Message from NC-ACS President

Dear Colleagues,

The COVID19 crisis has affected every aspect of our lives and we are all trying to make the best decisions to safeguard our patients, coworkers, staff, and families/friends. Because of this, we will be cancelling our Advocacy Day scheduled for May 6th in Raleigh. Your NC-ACS Leadership Team has been in communication with the SC ACS Chapter, the host Chapter for the 2020 meeting, and at this point the meeting is scheduled to proceed as planned. This decision will be re-evaluated in early May and any changes will be immediately communicated to you.

For the latest updates on how the American College of Surgeons is responding to this pandemic and what it means for your practice of surgery, please visit the website located here.

The challenges provided by the coronavirus pandemic are real and I realize we are all worried about what the future may bring. As surgeons many of us deal with stressful issues related to patient care on a daily basis and we are not unfamiliar to threats of physical harm, though not on a scale of this magnitude. This can be an opportunity to provide leadership and support to ongoing containment efforts at your institution or practice. Our chapter will also be looking at ways we can help surgeons across the state deal with this situation.

Best regards,
Perry Shen, MD, FACS
NC ACS Chapter President

Check out the uplifting and informative message from our very own J. Wayne Meredith, MD, FACS, MCCM, American College of Surgeons President-Elect.

Thank you for your unwavering leadership!

Issue 8 of the newsletter, ACS COVID-19 Update, is available now: https://www.facs.org/covid-19/newsletter/041420.  An introduction is on the body of the page and links to every topic specifically are on the left.

In this issue, there are a number of new developments to report, including the changes and findings in the coagulopathy of COVID with treatment strategies, ventilations strategies, convalescent plasma, well-being, CPR issues, financial issues and much more. The video sections are expanded with input from every level of ACS membership. Literally every aspect of this event is now being represented and reported.

All of the COVID-19 Update information from all sources is searchable on the tab to the left of the main text to assist in finding the exact information you need.

New Scoring System Empowers Surgery Departments to Prioritize Medically Necessary Operations that Should Not Be Delayed Because of Concerns About Hospital Resources or Risk Associated with COVID-19

Journal of the American College of Surgeons article presents an evaluation tool for surgeons to review necessary hospital resources needed for an operation, the effect of treatment delay on a patient’s underlying disease, and risk the procedure poses for the surgical team

CHICAGO (April 14, 2020): A team of investigators at the University of Chicago (Ill.), has devised a new scoring system that helps surgeons across surgical specialties decide when to proceed with medically necessary operations in the face of the resource constraints and increased risk posed by the Coronavirus Disease 2019 (COVID-19) pandemic. The process, called Medically Necessary Time-Sensitive (MeNTS) Prioritization, is published as an “article in press” on the Journal of the American College of Surgeons website ahead of print.

In the midst of the COVID-19 pandemic, hospitals must make sure they can care for the influx of patients who have advanced viral infection and therefore may require intensive care and the use of ventilators. Hospitals also must ensure that physicians, nurses, and other staff are not subjected to unnecessary risk of infection. At the same time, some patients that are not currently hospitalized still need surgical care that should be delayed for an excessive amount of time.

Decisions to proceed with MeNTS surgery at the present time are being made on a case-by-case basis, with surgeons following guidelines developed by individual surgical specialties, such as triaging breast cancer surgery recommendations developed by the COVID-19 Pandemic Breast Cancer Consortium1 and released on April 14. Prior to that release, ACS released an overall recommendation2 on March 13 that hospitals, health systems, and surgeons plan to minimize, postpone, or cancel elective operations until it is clear that the health care infrastructure can support critical care needs. This recommendation was followed by another more detailed guidance document released by ACS3 on March 17 to aid in surgical decision making in triaging operations that features an Elective Surgery Acuity Scale (ESAS) from St. Louis University.

The new methodology described by University of Chicago surgeons addresses what many call “elective” surgical procedures and is designed to guide both surgeons within a specialty and OR leaders across different specialties. “The majority of surgical procedures are done because of disease processes that do not have good nonsurgical treatment options. If you delay these procedures, that itself can lead to problems and complications. If cancer surgery is postponed indefinitely, for example, there is the potential risk that the disease will become more advanced.

“If a patient has pain in the hip or knee, the additional restrictions on mobility, not to mention the pain itself, are real issues. Although we talk about these operations as being ‘elective,’ that doesn’t mean they are optional. It’s just a matter of the surgeon and the patient having the opportunity to elect the time when the operation should take place. The procedures are more aptly called medically-necessary and time-sensitive,” explained Vivek N. Prachand, MD, FACS, lead author of the article, and professor of surgery and chief quality officer at University of Chicago Medicine and Biological Sciences.

The MeNTS Prioritization process was created by a team of six representatives from general surgery, vascular surgery, surgical oncology, transplantation, cardiac surgery, otolaryngology, and surgical ethics. The team reviewed studies of the effect of COVID-19 as well as severe acute respiratory syndrome on hospital resources, health care providers, surgical procedures, and surgical patients in Asia and Europe and identified 21 factors related to outcome, risk of viral transmission to health care professional, and use of resources.

“The nice thing about the system is that it applies not only to academic medical centers in big cities. It can be applied anywhere. The same assessment of resources is true wherever you practice.” Vivek N. Prachand, MD, FACS

“We studied how patients undergoing surgery might potentially be at increased risk of postoperative problems if they had COVID-19. We looked at surgical procedures individually and whether these operations routinely require an ICU stay; other currently scarce hospital resources; and/or general anesthesia, which increases the risk for spreading the virus to the health care team. We also thought about the disease process itself: how effective are non-surgical options? Would a wait of two weeks or six weeks make the operation riskier or more difficult to perform and increase the chance a patient might have complications or have to stay in the hospital longer?” Dr. Prachand added.

Each of the 21 factors is scored on a scale of 1 to 5, and the total score, ranging from 21 to 105, is computed for each case. The higher the score, the greater the risk to the patient, the higher the utilization of health care resources, and the higher the chance of viral exposure to the health care team. (See the linked sample MeNTS worksheet for a full list of the factors that are scored.)

University of Chicago surgeons have been using MeNTS for about two weeks, and they have increased the number of medically necessary, time-sensitive operations to about 15 per day, including colon resection for a painful bleeding cancer, removal of an infected hip replacement, urgent stereotactic brain biopsy of a relatively quickly growing diffuse brain tumor, and repair of a lacerated finger tendon.

The scoring system has been welcomed by University of Chicago specialties not originally involved in its creation, such as orthopedics, gynecology, and anesthesiology. “The MeNTS process gives our anesthesiology colleagues more reassurance that we are taking into consideration their risk in the care of certain patients. It also helps surgical trainees understand that decisions are being made in an equitable and transparent way,” Dr. Prachand said.

MeNTS may be used by any facility that is performing medically necessary, time-sensitive operations. “The nice thing about the system is that it applies not only to academic medical centers in big cities. It can be applied anywhere. The same assessment of resources is true wherever you practice. The factors are not hospital- or practice-environment-specific. These factors are fundamental and straightforward and can help surgeons and hospitals provide the surgical care that patients need both now in the thick of the pandemic as well as when we get to the other side of the peak,” Dr. Prachand said.

Dr. Prachand’s coauthors are Ross Milner, MD, FACS; Peter Angelos, MD, FACS; Mitchell C Posner, MD, FACS; John J Fung, MD, FACS; Nishant Agrawal, MD, FACS; Valluvan Jeevanandam, MD, FACa; and Jeffrey B Matthews, MD, FACS, all from the University of Chicago’s Department of Surgery.

The authors report no disclosures.

“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

Citation: Medically-Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. Journal of the American College of Surgeons. DOI: https:/doi.org/10.1016/j.jamcollsurg.2020.04.011
___
1. COVID-19 Pandemic Breast Cancer Consortium. Expert Medical Societies Release Multidisciplinary Recommendations for Breast Cancer Patient Care During COVID-19 Pandemic. Press release. Available at: https://www.facs.org/media/press-releases/2020/covid-breast-cancer041320. Accessed Aril 14, 2020.
2. American College of Surgeons. COVID-19: Recommendations for Management of Elective Surgical Procedures. Available at: https://www.facs.org/covid-19/clinical-guidance/elective-surgery. March 13, 2020. Accessed April 3, 2020.
3. American of Surgeons. COVID-19: Guidance for Triage of Non-emergent Surgical Procedures. Available at: https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage. March 17, 2020. Accessed April 3, 2020.

ACS Issues Local Resumption of Elective Surgery Guidance

Online April 17, 2020

 

In order to focus local resources on managing the new coronavirus (COVID-19) pandemic, “elective” surgery has been largely postponed and stopped. As the COVID-19 rates have already reached their peaks, or will do so over the next week or two (depending on location), the current focus for an increasing number of facilities is toward “ramping up” to prepare for elective operations.

The current document offers a set of principles and issues to help local facilities plan for resumption of elective surgical care.
 
While the effect of the COVID-19 pandemic on local communities or facilities is a spectrum, we suggest facilities use this checklist as a guide to ensure issues have at least been considered. Understanding both the local facility capabilities (e.g., beds, testing, operating rooms [ORs]) as well as potential constraints (e.g., workforce, supply chain), while keeping an eye on potential subsequent waves of COVID-19 will continue to be important.
 
Within the categories of I. COVID-19 Awareness, II. Preparedness, III. Patient Issues, and IV. Delivery of Safe High-Quality Care, there are 10 distinct issues to be addressed locally before elective surgery may be safely reinstituted. Evaluating and addressing each of these 10 issues will help facilities to not only optimally provide safe and high-quality surgical patient care, but also to ensure that surgery resumes, and doesn’t stop again.

Coronavirus Disease 2019 (COVID-19) Response in North Carolina

Click here for the latest information from the North Carolina Department of Health and Human Services.

Annual Resident Research, Trauma, and Cancer Paper Competition

2020 SC/NC Chapters of the American College of Surgeons Joint Annual Meeting
July 10-13, 2020
Marriott Resort (Grande Dunes) Myrtle Beach, SC

All abstract submissions must be done online.

All residents enrolled in general surgery or surgical specialty residency training programs in the states of South and North Carolina that have not completed training before July 2020 are eligible.
Medical students with an interest in surgery, enrolled in a SC or NC medical school, are eligible to submit for General Session and Cancer Competition only.  Medical students are NOT eligible
to submit for the Trauma Paper Competition.
The entry should represent original work done by the contestant while a resident in the state of South or North Carolina. The principal author of the essay must be that resident.


Note:  The deadline for submissions is June 12, 2020.

Click on the following link for the complete information and forms for abstract submissions.

American College of Surgeons Statement on PPE Shortages during the COVID-19 Pandemic

The American College of Surgeons (ACS) recognizes that many health care facilities are facing shortages of personal protective equipment (PPE), including face masks, gowns, and respirators. The ACS believes it is essential that surgeons, nurses, anesthesiologists, and other health care personnel be able to speak freely, without fear of retribution, as they seek to find a solution to accessing PPE. We advise surgeons to speak with their institutional leadership on these matters and to be able to direct any concerns to the ACS, with the goal of protecting themselves and their colleagues.

The Joint Commission has released a statement supporting the use of standard face masks and respirators provided from home when health care facilities cannot provide access to PPE that is commensurate with the risk to which health care personnel are exposed during the COVID-19 pandemic. Where masks or respirators are recommended, the ACS maintains that surgeons should have access to and latitude to wear these masks at their sole discretion. 

The Centers for Disease Control and Prevention (CDC) also has released a document that offers a series of strategies or options to optimize supplies of disposable N95 filtering facepiece respirators. 

The ACS strongly supports the ability of surgeons to use their own masks or other PPE, but this option does not obviate the hospital’s responsibility to provide adequate PPE to all their health care workers. In these extraordinary times, the ACS encourages institutions to adapt and be flexible so that health care personnel continue to feel safe; The Joint Commission guidelines are a reasonable starting point.

2020 SC/NC Chapters of the American College of Surgeons Joint Annual Meeting

Make plans to attend the upcoming Annual Meeting of the South Carolina and North Carolina Chapters of the American College of Surgeons, Bariatric Society of the Carolinas and the South Carolina Vascular Surgical Society scheduled for July 10-12, 2020 at the Marriott Resort and Spa (Grande Dunes) in Myrtle Beach, SC.

Click on the following link to register online. 

Also the link for the hotel reservations at the Marriott Resort and Spa is here (please note the hotel will release any rooms left in our block on June 8, 2020).

Book your group rate for SC Chapter American College of Surgeons 2020.

It’s Time To Pay Your Dues! 

If you have already paid your North Carolina ACS dues for 2020, THANK YOU!  If you haven’t, why not click here and do it now.  And ask your colleagues to join and support North Carolina ACS.  We are stronger together.
Send your news items to Kathy Browning (kathyb@ncfacs.org)

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Do you participate in #SurgTweeting?  Don’t forget to follow your NC-ACS Chapter on Twitter at @NCSurgeons.  Follow and mention us in your tweets! We will retweet! We are also on Facebook and LinkedIn

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