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Review
. 2020 Sep;90(9):1558-1565.
doi: 10.1111/ans.16196. Epub 2020 Aug 17.

Surgery triage during the COVID-19 pandemic

Wendy J Babidge  1   2 , David R Tivey  1   2 , Joshua G Kovoor  3 , Kristin Weidenbach  1 , Trevor G Collinson  4 , Peter J Hewett  2 , Thomas J Hugh  5   6 , Robert T A Padbury  7   8 , Nicola M Hill  9 , Guy J Maddern  1   2
Affiliations
Review

Surgery triage during the COVID-19 pandemic

Wendy J Babidge et al. ANZ J Surg. 2020 Sep.

Abstract

Background: The novel coronavirus, SARS-CoV-2, caused the COVID-19 global pandemic. In response, the Australian and New Zealand governments activated their respective emergency plans and hospital frameworks to deal with the potential increased demand on scarce resources. Surgical triage formed an important part of this response to protect the healthcare system's capacity to respond to COVID-19.

Method: A rapid review methodology was adapted to search for all levels of evidence on triaging surgery during the current COVID-19 outbreak. Searches were limited to PubMed (inception to 10 April 2020) and supplemented with grey literature searches using the Google search engine. Further, relevant articles were also sourced through the Royal Australasian College of Surgeons COVID-19 Working Group. Recent government advice (May 2020) is also included.

Results: This rapid review is a summary of advice from Australian, New Zealand and international speciality groups regarding triaging of surgical cases, as well as the peer-reviewed literature. The key theme across all jurisdictions was to not compromise clinical judgement and to enable individualized, ethical and patient-centred care. The topics reported on include implications of COVID-19 on surgical triage, competing demands on healthcare resources (surgery versus COVID-19 cases), and the low incidence of COVID-19 resulting in a possibility to increase surgical caseloads over time.

Conclusion: During the COVID-19 pandemic, urgent and emergency surgery must continue. A carefully staged return of elective surgery should align with a decrease in COVID-19 caseload. Combining evidence and expert opinion, schemas and recommendations have been proposed to guide this process in Australia and New Zealand.

Keywords: COVID-19; health resources; personal protective equipment; surgery; surgical specialties; triage.

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Conflict of interest statement

None declared.

Figures

Fig 1
Fig 1
Recommendations derived from rapid review of existing guidelines.
Fig 2
Fig 2
Advised schema for Elective Surgery Triage within Australia (developed by COVID‐19 Working Group).
Fig 3
Fig 3
Advised schema for Elective Surgery Triage within New Zealand (developed by the New Zealand National Board).
See this image and copyright information in PMC

References

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    1. COVID‐19 Public Health Response Strategy Team Ministry of Health, New Zealand Government . Background and Overview of Approaches to COVID‐19 Pandemic Control in Aotearoa/New Zealand. [Cited 9 May 2020.] Available from URL: https://www.health.govt.nz/system/files/documents/publications/backgroun...
    1. Ministry of Health New Zealand Government . New Zealand Influenza Pandemic Plan: A Framework for Action, 2nd edn. Wellington: Ministry of Health, 2017.

MeSH terms