Table 1.
UW OMS Surgery Acuity Scale
| Tier | Definition | Location | Examples (per CODA OMS Residency Training Categories) | Action | COVID-19 Testing |
|---|---|---|---|---|---|
| 1a | Low acuity surgery/healthy patient (ASA 1-2); outpatient surgery; not life-threatening illness | OMS OP; HOPD; ASC | Dentoalveolar surgery, asymptomatic; routine outpatient anesthesia; implant therapy; facial trauma (eg, arch bar removal); orthognathic surgery; cosmetic surgery; benign pathology; reconstruction; TMJ | Postpone surgery | NA |
| 1b | Low acuity surgery/unhealthy patient (ASA 3-5) | OMS OP; HOPD; ASC | Dentoalveolar surgery, asymptomatic; routine outpatient anesthesia; implant therapy; facial trauma (eg, arch bar removal); orthognathic surgery; cosmetic surgery; benign pathology; reconstruction; TMJ | Postpone surgery or proceed with appropriate PPE∗ if medical history necessitates procedure | Negative within 72 hours |
| 2a | Intermediate acuity/healthy patient (ASA 1-2); not life-threatening but potential for future morbidity and mortality within 90 days; requires hospital admission | OMS OP; HOPD; ASC | Odontogenic infection; dental extraction, symptomatic; facial trauma (eg, minimally displaced fracture, simple mandible fracture, closed condyle fracture, zygoma, and/or zygomatic arch); benign pathology; reconstruction | Postpone surgery (medical management) or proceed with appropriate PPE∗ and consider the following: trauma: closed reduction, self-drilling screws, limit drilling; delay complex reconstruction where possible (eg, free flaps) | Negative within 72 hours or consider rapid test |
| 2b | Intermediate acuity/unhealthy patient (ASA 3-5) | Hospital | Odontogenic infection; dental extraction, symptomatic; facial trauma (eg, minimally displaced fracture, simple mandible fracture, closed condyle fracture, zygoma, and/or zygomatic arch); benign pathology; reconstruction | Postpone surgery (medical management) or proceed with appropriate PPE∗ and consider the following: trauma: closed reduction, self-drilling screws, limit drilling; delay complex reconstruction where possible (eg, free flaps) | Negative within 72 hours or consider rapid test |
| 3a | High acuity surgery/healthy patient (ASA 1-2); life-threatening and/or high potential for future morbidity and mortality within 90 days; requires hospital admission | Hospital | Odontogenic infection; facial trauma (eg, comminuted open fractures, panfacial injury, ocular emergency, soft tissue injury); head and neck cancer | Proceed with appropriate PPE∗; if nonoperative therapy is equivalent to surgery (eg, radiotherapy), nonoperative therapy is recommended | Negative within 72 hours or consider rapid test |
| 3b | High acuity/unhealthy patient (ASA 3-5) | Hospital | Odontogenic infection; facial trauma (eg, comminuted open fracture, panfacial injury, ocular emergency, soft tissue injury); head and neck cancer | Proceed with appropriate PPE∗; if nonoperative therapy is equivalent to surgery (eg, radiotherapy), nonoperative therapy is recommended | Negative within 72 hours or consider rapid test |
Data adapted from American College of Surgeons.21
Abbreviations: AGP, aerosol-generating procedure; ASA, American Society of Anesthesiologists; ASC, ambulatory surgery center; CODA, Commission on Dental Accreditation; COVID-19, coronavirus disease 2019; HOPD, hospital outpatient department; OMS, oral and maxillofacial surgery; OP, office-based clinic/practice; PAPR, powered air purifying respirator; PPE, personal protective equipment; SC2, SARS-CoV-2; TMJ, temporomandibular joint; UW, University of Washington.
Appropriate PPE—for COVID-19 (SC2) test negative: standard precautions (ie, mask, face shield or goggles; gown, surgical cap, gloves); for COVID-19 (SC2) test positive or unknown: 1) for AGP—airborne respirator/contact precautions (PAPR, N95, eye shield or goggles, gown, surgical cap, gloves), trained observer for donning and doffing, negative pressure room, if available; 2) for non-AGP—standard plus droplet and contact precautions (surgical mask, eye shield or goggles, gown, surgical cap, gloves), trained observer for donning and doffing.