Introduction
Since its initial identification in Wuhan, China, in late 2019, the novel coronavirus 2019 disease (COVID-19) has rapidly spread across the world. In recognition the World Health Organization (WHO) officially designated the COVID-19 outbreak a pandemic on March 11, 2020.1 The rapid rise in COVID-19 cases has caused a demand surge on the United States healthcare system. Hospitals are already reporting shortages of necessary equipment and resources required to care for COVID-19 patients including personal protective equipment (PPE) for frontline healthcare workers, ventilators, intensive care unit (ICU) beds, and transfusion capacity.
Surgical procedures increase demands on an already taxed system through the consumption of a large amount of PPE, use of inpatient beds post-operatively, and elevated risk of transmission of SARS-CoV-2 to other patients and staff.2,3 The CDC recommended cancellation of all elective and non-urgent procedures for Santa Clara County, California, on March 12, 2020.2 Subsequent guidelines were released by the American College of Surgeons (ACS) to curtail the performance of “elective” surgical procedures4 and the American Academy of Otolaryngology-Head and Neck Surgery to provide only “time-sensitive” or “emergent” care.5 While the ACS6 and the Centers for Medicare & Medicaid Services (CMS)3 have published general guidelines on priority classification of cases, it is ultimately the responsibility of the surgeon to define “elective” and “urgent” surgery. The ACS, working together with specialty societies, has put forth more specific definitions of procedural classifications for other surgical specialties4, including cardiac, colorectal, metabolic and bariatric, pediatric, and thoracic surgery; however, to date, no otolaryngology case priority designations exist.
In response to this pandemic, the Division of Head and Neck Surgery in the Department of Otolaryngology at Stanford University has developed a process for stratifying head and neck cases by urgency. In the present commentary, we discuss considerations for case prioritization during the COVID-19 pandemic, outline our criteria and workflow, define estimated risk categories of SARS-CoV-2 transmission for patients undergoing urgent head and neck surgery, and discuss the role of preoperative COVID-19 screening.