Approaching "Elective" Surgery in the Era of COVID-19

Area of Science:

• Medical Ethics
• Health Policy
• Surgical Prioritization

Background:

• The coronavirus disease 2019 (COVID-19) pandemic strained healthcare systems globally, leading to the suspension of elective surgeries.
• Delays in hand surgery, often elective, can negatively impact patient outcomes.
• Resource scarcity necessitates a structured approach to surgical prioritization.

Purpose of the Study:

• To develop an ethical framework for prioritizing elective surgeries during periods of healthcare resource scarcity.
• To redefine "elective" procedures based on safety and impact of delay.
• To provide guidance for managing surgical backlogs in crisis situations.

Main Methods:

• Proposed a 3-criterion framework for determining safe surgical delays: prevention of permanent injury, manageable future costs, and preservation of patient autonomy.
• Applied the framework to three case examples in hand surgery, considering patient-specific factors and disease pathophysiology.
• Designed the framework for applicability to ambulatory surgery during crises.

Main Results:

• Identified criteria for safely delaying surgical procedures without compromising patient outcomes or ethical principles.
• Demonstrated the framework's utility through case study analysis.
• Highlighted the framework's adaptability to various crisis scenarios impacting healthcare resources.

Conclusions:

• The proposed ethical framework offers a systematic method for prioritizing surgeries when resources are limited.
• This approach ensures that decisions about delaying care are ethically sound and clinically justifiable.
• The framework is adaptable for ambulatory settings during crises, with potential modifications for inpatient procedures.