How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic.
Author(s)
Type
Journal Article
Abstract
AIMS: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. RESULTS: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 were most likely to undergo surgery, including those deemed high-risk. This model, which includes assessment of biopsychosocial factors alongside disease severity, can assist in equitably prioritizing the substantial list of patients now awaiting planned orthopaedic surgery worldwide. Cite this article: Bone Jt Open 2021;2(2):134-140.
Date Issued
2021-02-25
Date Acceptance
2021-02-01
Citation
Bone & Joint Open, 2021, 2 (2), pp.134-140
ISSN
2633-1462
Publisher
British Editorial Society of Bone and Joint Surgery
Start Page
134
End Page
140
Journal / Book Title
Bone & Joint Open
Volume
2
Issue
2
Copyright Statement
© 2021 Author(s) et al. This is an open-access article distributed under the terms of
the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0)
licence, which permits the copying and redistribution of the work only, and provided
the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0)
licence, which permits the copying and redistribution of the work only, and provided
the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33630719
Subjects
COVID-19
Health equity
Orthopaedics
Surgery
Waiting lists
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-02-25