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Surgery triage during the COVID-19 pandemic.
ANZ J Surg. 2020 09; 90(9):1558-1565.AJ

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.

Authors+Show Affiliations

Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.University of Adelaide, Adelaide, South Australia, Australia.Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.General Surgeons Australia, Adelaide, South Australia, Australia.Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia. Surgical Education, Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.Flinders University, Adelaide, South Australia, Australia. Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, Australia.Nelson-Marlborough District Health Board, New Zealand National Board, Royal Australasian College of Surgeons, Nelson, New Zealand.Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32687241

Citation

Babidge, Wendy J., et al. "Surgery Triage During the COVID-19 Pandemic." ANZ Journal of Surgery, vol. 90, no. 9, 2020, pp. 1558-1565.
Babidge WJ, Tivey DR, Kovoor JG, et al. Surgery triage during the COVID-19 pandemic. ANZ J Surg. 2020;90(9):1558-1565.
Babidge, W. J., Tivey, D. R., Kovoor, J. G., Weidenbach, K., Collinson, T. G., Hewett, P. J., Hugh, T. J., Padbury, R. T. A., Hill, N. M., & Maddern, G. J. (2020). Surgery triage during the COVID-19 pandemic. ANZ Journal of Surgery, 90(9), 1558-1565. https://doi.org/10.1111/ans.16196
Babidge WJ, et al. Surgery Triage During the COVID-19 Pandemic. ANZ J Surg. 2020;90(9):1558-1565. PubMed PMID: 32687241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery triage during the COVID-19 pandemic. AU - Babidge,Wendy J, AU - Tivey,David R, AU - Kovoor,Joshua G, AU - Weidenbach,Kristin, AU - Collinson,Trevor G, AU - Hewett,Peter J, AU - Hugh,Thomas J, AU - Padbury,Robert T A, AU - Hill,Nicola M, AU - Maddern,Guy J, Y1 - 2020/08/17/ PY - 2020/05/17/received PY - 2020/07/08/revised PY - 2020/07/10/accepted PY - 2020/7/21/pubmed PY - 2020/9/26/medline PY - 2020/7/21/entrez KW - COVID-19 KW - health resources KW - personal protective equipment KW - surgery KW - surgical specialties KW - triage SP - 1558 EP - 1565 JF - ANZ journal of surgery JO - ANZ J Surg VL - 90 IS - 9 N2 - 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. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/32687241/Surgery_triage_during_the_COVID_19_pandemic_ L2 - https://doi.org/10.1111/ans.16196 DB - PRIME DP - Unbound Medicine ER -