Coronavirus disease 2019 pandemic: staged management of surgical services for gynecology and obstetrics

Published:April 03, 2020DOI:
      The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        Regional Office for Europe. Hospital emergency response checklist: an all-hazards tool for hospital administrators and emergency managers.
        (Available at:)
        • Ingrassia P.L.
        • Mangini M.
        • Azzaretto M.
        • et al.
        Hospital disaster preparedness in Italy: a preliminary study utilizing the World Health Organization Hospital Emergency Response Evaluation Toolkit.
        Minerva Anestesiol. 2016; 82: 1259-1266
        • Kelen G.D.
        • McCarthy M.L.
        • Kraus C.K.
        • et al.
        Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events.
        Disaster Med Public Health Prep. 2009; 3: S10-S16
        • DeLia D.
        • Wood E.
        The dwindling supply of empty beds: implications for hospital surge capacity.
        Health Aff (Millwood). 2008; 27: 1688-1694
        • Soremekun O.A.
        • Zane R.D.
        • Walls A.
        • Allen M.B.
        • Seefeld K.J.
        • Pallin D.J.
        Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity-a pilot study.
        Prehosp Disaster Med. 2011; 26: 224-229
        • Kanter R.K.
        • Moran J.R.
        Hospital emergency surge capacity: an empiric New York statewide study.
        Ann Emerg Med. 2007; 50: 314-319
        • American College of Surgeons
        COVID-19: recommendations for management of elective surgical procedures.
        (Available at:)
        • American College of Obstetricians and Gynecologists
        Joint statement on elective surgeries.
        (Available at:)
        • U.S. Surgeon General
        Hospitals & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve.
        (Available at:)
        • Peeri N.C.
        • Shrestha N.
        • Rahman M.S.
        • et al.
        The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned?.
        Int J Epidemiol. 2020; ([Epub ahead of print])
        • Rasmussen S.A.
        • Smulian J.C.
        • Lednicky J.A.
        • Wen T.S.
        • Jamieson D.J.
        Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.
        Am J Obstet Gynecol. 2020; ([Epub ahead of print])
        • Wu Z.
        • McGoogan J.M.
        Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.
        JAMA. 2020; ([Epub ahead of print])
        • Grasselli G.
        • Pesenti A.
        • Cecconi M.
        Critical care utilization for the COVID-19 outbreak in. Lombardy, Italy: early experience and forecast during an emergency response.
        JAMA. 2020; ([Epub ahead of print])