Rescheduling of Cancelled Elective Surgical Procedures Among Older Adults Post-COVID-19

The COVID-19 pandemic has recently put a stop to elective surgical procedures across Canada, inherently compounding already lengthy waitlists that exist within most disciplines of surgery. These long waits for elective procedures within Canadian provinces have not been caused by the COVID-19 pandemic; it is an acute-on-chronic issue that has been exacerbated by the ongoing COVID-19 pandemic. As hospitals begin to reschedule elective surgeries, patients are likely to be prioritized by clinical urgency using both established and newly created surgical triage severity scales. The objective of this commentary is to discuss issues related to the rebooking of elderly surgical patients during the COVID-19 pandemic within the context of northern medicine. Northern and rural hospitals may already face a multitude of barriers related to the rebooking of surgical patients due to a paucity of available surgical resources, as well as difficulties related to accessing care at the local level. While current surgical rebooking tools have been developed in response to the COVID-19 pandemic, they fail to explore certain risks related to the older adult population which may lead to increased mortality and morbidity. Review of the literature indicates that redistribution of surgical resources for older adults in the COVID-19 era will require consideration of clinical medical ethics vs. population health ethics regarding who should be prioritized in re-bookings for elective surgical procedures. This should be done in conjunction with encompassing surgical triage severity scales specifically made for older adults in the time of COVID-19.