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Hospitals are canceling elective surgeries to respond to COVID. Here’s what you need to know

Canceling even a small number of elective procedures can make a big difference in terms of hospital capacity said Dr. Ravin Davidoff, chief medical officer at Boston Medical Center.Erin Clark/Globe Staff

As the COVID-19 crisis escalates again in Massachusetts, the state’s hospitals are working to add capacity so they can treat growing numbers of patients. Beginning Friday, under an order from the Baker administration, hospitals are canceling or postponing certain elective procedures so they have more space to dedicate to COVID patients.

This means some patients with other conditions will have to wait weeks or months before they can receive care. But Governor Charlie Baker said it’s necessary because of the “disturbing” rise in the number of people getting sick from the virus.

Here’s what you need to know about hospitals canceling elective procedures:

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What is the state requiring?

The state Department of Public Health told hospitals this week to postpone or cancel “nonessential elective invasive procedures” that require patients to stay overnight in a hospital. State health officials allow doctors to use their clinical judgment when deciding which procedures to cancel. Officials also are calling on hospitals to support the redeployment of certain staff from elective procedures to “essential” services.

Many hospitals were taking these steps before the new order.

“Hospitals for the last several weeks have been adjusting their schedules based on bed capacity,” said Steve Walsh, president of the Massachusetts Health & Hospital Association. “There was an increase in need for inpatient beds after the Thanksgiving holiday, and hospitals had to cancel scheduled events to meet demand.”

Why is this happening now?

The number of people with COVID who are sick enough to be hospitalized has been rising for many weeks. The trends appear to have worsened after Thanksgiving, as feared.

As of Friday, 1,605 COVID patients were hospitalized in Massachusetts. That’s almost 300 more than a week earlier, and about 600 more than the week of Thanksgiving.

Hospitals are not overwhelmed, but they are busy and getting busier.

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“We are seeing alarming trends,” said Jennifer Kritz, spokeswoman for the Beth Israel Lahey Health system, which already scaled back some non-urgent procedures before the governor’s order. “The statewide approach will allow the state’s health care system to safely and effectively manage the resurgence.”

Many surgeries require patients to stay one or several nights in the hospital. Canceling even a few of these can make a difference in a crisis.

“Fifteen beds or twenty beds — it makes a huge difference in terms of capacity,” said Dr. Ravin Davidoff, chief medical officer at Boston Medical Center. “Anytime you reduce something, you create more capacity.”

What is being canceled?

“Elective” broadly applies to any procedure that is scheduled in advance. It doesn’t mean a procedure is optional or unimportant, just that it is not an emergency.

Elective does not mean discretionary, said Dr. Gerard M. Doherty, surgeon-in-chief at Brigham and Women’s Hospital. “Almost all of our operations are necessary procedures that people don’t choose to have — they need to have them done.”

The state has instructed hospitals to cancel procedures that can be put off for weeks or months without a risk of harm to patients. This includes many orthopedic surgeries, such as hip and knee replacements. It could apply to hernia repairs, bariatric weight loss surgery, and surgery to fix issues that have been lingering for years.

Rather than canceling all joint replacement surgeries, however, hospital leaders say they are deciding what to put off based on individual patients’ needs.

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What kinds of procedures are continuing?

For now, most scheduled procedures will continue.

Surgeons plan to keep operating on patients who could get sicker if their care is delayed. This includes people with serious heart conditions, advanced tumors, and severe pain. Most cancer surgery is expected to continue, except for cases in which a cancer may be slow-growing.

“We are selecting cases where there will be no harm by a delay,” said Dr. David McAneny, chief surgical officer at Boston Medical Center. “If it’s someone whose health would be adversely affected by a delay, we would consider that essential and continue that operation.”

Outpatient procedures, which are done during the day and do not require admission to the hospital, also will continue for now. They include cancer screenings such as mammograms and colonoscopies.

State health officials specifically noted that preventive services, pediatric care, and immunizations should continue. These services do not affect the number of beds available to treat sick COVID patients.

Is this what hospitals did during the first surge?

This round of cancellations is smaller and more targeted than what hospitals did during the first surge of COVID in the spring.

At that time, the cancellations were widespread as hospitals braced for an onslaught of patients with a then-unfamiliar disease. The Brigham, which does about 600 operations each week, reduced its caseload 80 percent in the spring. Now, the cancellations reflect about 10 percent of scheduled procedures, Doherty said.

Similarly, Boston Medical Center cut surgeries by 90 percent in the spring, and is reducing by about 10 percent now, McAneny said.

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Many of those canceled procedures were rescheduled for the summer months when the incidence of COVID dropped in Massachusetts.

Hospitals are trying to avoid a repeat of the broad cancellations done in the spring, which could be harmful to patients who urgently need treatment for conditions unrelated to COVID. But if the COVID crisis escalates too rapidly, more cancellations could be inevitable.

“We don’t know how long this pressure on the inpatient bed supply is going to last,” Doherty said. “We know that through next week, we project we’re going to have very full hospitals” — not just because of COVID but because of other seasonal issues such as flu.

“There’s a lot of unknowns,” said Walsh, of the hospital association. “There’s always a chance that things could evolve.”


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.