| The Surgical Technologist | JULY 2022 320 TABLE 6 | Cardiothoracic & Vascular Elective Surgery Acuity Scale (ESAS). All candidates for surgery should be assessed for surgical fitness on an individual basis. This is an example ESAS and not comprehensive. Procedure acuity for the individual patient may shift among tiers based upon acuity of illness, severity of COVID19 infection and coagulopathy, and hospital surgical capacity (135, 140, 141). For specific length of operative delay, please see the text and Association of Anesthesiologists guidelines (13). Tier 1 Low Acuity Delay Tier 2 Intermediate Acuity Delay if possible Tier 3 High Acuity Do not delay Aortic aneurysm AAA < 6.5 cm AAA or TAA > 6.5 cm Ruptured or symptomatic AAA or TAA Associated with infection or prosthetic infection Bypass graft complications Asymptomatic bypass graft/ stent stenosis Revascularization for high grade re-stenosis of previous intervention Infected arterial prosthesis Carotid Asymptomatic carotid artery stenosis Symptomatic carotid stenosis: TCAR and CEA Cardiac Asymptomatic mitral regurgitation Isolated arrhythmia procedure Symptomatic mitral regurgitation PFO or ASD surgery Symptomatic aortic stenosis Severe CAD Dialysis n/a Fistula revision for malfunction/ steal Fistulagram for malfunction AV fistula and graft placement for dialysis (ESRD, CK4, and CK5 only) Infected dialysis access Tunneled dialysis cathetersa Thrombosed or nonfunctional dialysis access Fistula revision for ulceration Mesenteric n/a Chronic mesenteric ischemia Symptomatic acute mesenteric ischemia Peripheral vascular disease Surgical procedures for claudication Chronic limb threatening ischemia Acute limb ischemia Thoracic outlet syndrome Neurogenic TOS TOS, venous Symptomatic venous TOS with acute occlusion and marked edema TOS, arterial with thrombosis Venous Varicose veins IVCfilter removal Asymptomatic May Thurner syndrome Procedures for ulcerations secondary to venous disease IVCfilter placement Acute iliofemoral DVT with phlegmasia Abbreviations: AAA, abdominal aortic aneurysm; ASD, atrial septal defect; AV, arteriovenous; CAD, coronary artery disease; CEA, carotid endarterectomy; CK, chronic kidney disease; DVT, deep vein thrombosis; ESRD, end stage renal disease; IVC, inferior vena cava; PFO, patent foramen ovale; TAA, thoracic aortic aneurysm; TCAR, transcarotid artery revascularization; TOS, thoracic outlet syndrome. aMay be placed in emergent situations which allow for postponement of the definitive fistula or graft surgery. TABLE 7 | Plastic, Oculoplastic, and Reconstructive Elective Surgery Acuity Scale (ESAS). All candidates for surgery should be assessed for surgical fitness on an individual basis. This is an example ESAS and not comprehensive. Procedure acuity for the individual patient may shift among tiers based upon acuity of illness, severity of COVID-19 infection and coagulopathy, and hospital surgical capacity (199–201). For specific length of operative delay, please see the text and Association of Anesthesiologists guidelines (13). Tier 1 Low Acuity Delay Tier 2 Intermediate Acuity Delay if possible Tier 3 High Acuity Do not delay Oculoplastic Blepharoplasty Slow-growing BCC Chalazion drainage Ptosis repair Cutaneous malignancy other than slow-growing BCC Amblyopia in an infant Orbital exploration for non-vision threatening conditions Canthotomy Orbital abscess drainage Optic nerve sheath fenestration Dacryocele decompression in a neonate Plastic & Reconstructive Revision reconstructive breast surgery Cosmetic surgery Non-melanoma skin cancer biopsy/resection/ grafting ORIF of maxillofacial fractures Digit replantation Skull base reconstruction 3rd-degree burns Fasciotomy for acute compartment syndrome Necrotizing fasciitis debridement Abbreviations: BCC, basal cell carcinoma; ORIF, open reduction internal fixation. Bunch et al. COVID-19 Immuno-Thrombosis and Surgery Frontiers in Surgery | www.frontiersin.org 16 2022 | Volume 9 | Article 889999
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