With the closure of most operating rooms (ORs) during the coronavirus disease 2019 (COVID-19) pandemic, the traditional allocation of block OR time needed to be redesigned. An important factor permitting the treatment of patients in a prioritized fashion was our pre-existing centralized OR booking (CORB) framework, which already required surgeons to categorize the priority level for each patient. The CORB, in conjunction with the multidisciplinary OR oversight committee that was formed during COVID-19 to review and triage the urgent cases, allowed for prioritization of cases among surgical services. Centralized OR booking provided opportunities that were essential in OR planning during the pandemic, including the ability to plan surgeries to maximize OR efficiency, minimize the number of admissions on any given day to the wards and the intensive care unit, flatten the number of admissions over the week and provide the flexibility to ramp up or down the number of ORs as the crisis changed.