Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines

Bouthillier, Marie-Ève; Lorange, Michel; Legault, Serge; Wade, Lucie; Dahine, Joseph; Latreille, Jean; Germain, Isabelle; Grégoire, R.; Montpetit, P; Prady, Catherine; Thibault, Elise; Dumez, Vincent; Opatrny, Lucie

doi:10.1503/cjs.022220

Cited by 15 publications

(14 citation statements)

References 4 publications

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“…During the pandemic period, oncology procedures were preserved and there was a higher proportion of emergency surgeries compared to the pre-pandemic baseline. This pattern reflects institutional and governmental prioritization policies [ 15 ]. Trauma surgery volumes decreased to 71% of the pre-pandemic baseline likely related to strict stay-at-home orders in Quebec [ 1 ] and the decrease in automobile use and sports.…”

Section: Discussionmentioning

confidence: 91%

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures

et al. 2022

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Introduction During the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate the impact of the first wave of the pandemic on the participation of general surgery residency and fellowship trainees in operative procedures. Methods This study is a retrospective review of all adult general surgery procedures performed at 3 sites of an academic health care network. Cases performed during the first wave of the pandemic (March–June 2020) were compared to the same period of the previous year pre-pandemic (March–June 2019). Trainees were categorized as junior (Post-Graduate-Year [PGY] 1–2), senior (PGY3-5), or fellows (PGY6-7). Operating exposure was defined as (1) the total number of cases attended by at least one trainee and (2) total time spent in the OR by all trainees (hours). The impact of the pandemic was estimated as percentage of baseline (2019). Results During the first wave of the pandemic, a total of 914 cases were performed, compared to 1328 in the pre-pandemic period (69%). Junior trainees were more affected than senior trainees with reductions in both case volume (68% versus 78% of baseline attendance) and time (68% versus 77% of baseline operating time). Minimally invasive surgery fellows were most severely affected trainees and colorectal fellows were least affected (14% and 75% of baseline cases, respectively). Participation in emergency surgery cases and surgical oncology cases was relatively preserved (87% and 105% of baseline, respectively). Conclusions The first wave of the COVID-19 pandemic reduced operative exposure for general surgery trainees by approximately 30%. Procedure-specific patterns reflected institutional policies for prioritizing cancer operations and emergency surgeries. These findings may inform the design of remediation activities to mitigate the impact of the pandemic on surgical training.

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Section: Discussionmentioning

confidence: 91%

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures

et al. 2022

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“…Moreover, prioritization based on health effects has to be weighed against the relative importance of other factors and considerations such as urgency, waiting time, patient preferences, solidarity and fairness. Recently, several attempts have been made to reach consensus on the use of different prioritization criteria and the operationalisation in clinical practice ( Bouthillier et al, 2021 ; Valente et al, 2021 ; van der Horst et al, 2022 ). Further research on the implementation and impact of prioritization on health effects is needed to assess its feasibility and value.…”

Section: Discussionmentioning

confidence: 99%

Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands

Oosterhoff

Kouwenberg

Rotteveel

et al. 2023

Social Science & Medicine

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“…This might be explained by the COVID-19-related guidelines of each country. The ministry of health of Quebec in March 2020 implemented the protocol of systematically prioritizing resources away from surgical care to patients with COVID-19, which reduced surgical activities to a minimum, leaving operating rooms to run semi-urgent and urgent surgeries only [ 25 ]. Cancer treatment delay during a pandemic is a problem for the health system worldwide, and the long-term consequences are yet to be determined.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center

et al. 2022

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Background: We have recently reported a 35% drop in new lung cancer diagnoses and a 64% drop in lung cancer surgeries during the first year of the pandemic. Methods: The target population was divided into three cohorts: pre-COVID-19 (2019), first year of COVID-19 (2020), and second year of COVID-19 (2021). Results: The number of new lung cancer diagnoses during the second year of the pandemic increased by 75%, with more than 50% being in the advanced/metastatic stage. There was a significant increase in cases with multiple extrathoracic sites of metastases during the pandemic. During the first year of the pandemic, significantly more patients were treated with radiosurgery compared to the pre-COVID-19 year. During the second year, the number of radiosurgery and surgical cases returned to pre-COVID-19 levels. No significant changes were observed in systemic chemotherapy and targeted therapy. No statistical difference was identified in the mean wait time for diagnosis and treatment during the three years of observation. However, the wait time for surgery was prolonged compared to the pre-COVID-19 cohort. Conclusions: The significant drop in new diagnoses of lung cancer during the first year of the pandemic was followed by an almost two-fold increase in the second year, with the increased rate of metastatic disease with multiple extra-thoracic site metastases. Limited access to surgery resulted in the more frequent use of radiosurgery.

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Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines

Cited by 15 publications

References 4 publications

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures

Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer over a 2-Year Period at a Canadian Academic Center

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