Elective Surgery Acuity Scale (ESAS)

After the American College of Surgeons released initial recommendations on March 13 asking surgeons to "thoughtfully review" all elective procedures and plan to minimize, postpone, or cancel cases until we are past the inflection point of exposure, many of us asked ourselves the question, how elective is elective?

To help with this question, the ACS released a revised statement on March 17 suggesting use of the Elective Surgery Acuity Scale (ESAS) from St. Louis University, which is copied below. In making this decision, the surgeon must weigh what medical risks the patient may or will incur by case delay, assuming an expected delay of 6-8 weeks. Additional considerations related to provider and resource allocation will differ depending on institutions. Note that "most cancers" fall into Tier 3a, cases which should not be postponed.

The ACS recommends moving lower acuity cases to ambulatory surgical centers if the surgeon feels the case should not wait and can be performed at such a location. Post-operative management after surgery (including inpatient vs outpatient status) at an ambulatory center, however, is not clearly delineated in this document.

More information for surgeons from the ACS can be found here: https://www.facs.org/about-acs/covid-19/information-for-surgeons