Approaching "Elective" Surgery in the Era of COVID-19

The Journal of Hand Surgery
Stephen D LockeyMichael W Kessler

Abstract

The coronavirus disease 2019 pandemic created unprecedented challenges for the health care system. To meet capacity demands, hospitals around the world suspended surgeries deemed to be elective. In hand surgery, numerous pathologies are treated on an elective basis, but a delay or absence of care may result in poorer outcomes. Here, we present an ethical framework for prioritizing elective surgery during a period of resource scarcity. Instead of using the term "elective," we define procedures that can be safely delayed on the basis of 3 considerations. First, a safe delay is possible only if deferral will not result in permanent injury. Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy. In considering these criteria, 3 case examples are discussed considering individual patient characteristics and the pathophysiology of the condition. This framework design is applicable to ambulatory surgery in any period of crisis that may strain resources, but further considerations may be important if an operation requires hospital admission.

References

Sep 1, 1990·The Journal of Hand Surgery·D J PogueJ A Hokanson
Oct 10, 2002·Hand Clinics·Susan E Mackinnon
Nov 24, 2004·The Journal of Orthopaedic and Sports Physical Therapy·Joy C MacDermid, Tim Doherty
Mar 6, 2007·The Journal of Hand Surgery·Walter H ShortJean Paul Brutus
May 8, 2007·The Journal of Hand Surgery·Krista E Weiss, Craig M Rodner
Sep 4, 2012·Hand : Official Journal of the American Association for Hand Surgery·Louis F AmorosaRobert A Kaufmann
Sep 1, 2011·Geriatric Orthopaedic Surgery & Rehabilitation·Rohit AroraMartin Lutz
Feb 16, 2017·The Journal of the American Academy of Orthopaedic Surgeons·L Scott LevinNicholas Pulos
Oct 27, 2017·EFORT Open Reviews·Jonny K Andersson
Mar 4, 2018·The Orthopedic Clinics of North America·Benjamin M Mauck, Colin W Swigler
Apr 18, 2018·The Journal of Bone and Joint Surgery. American Volume·Muhanned AliIsam Atroshi
Feb 9, 2019·The Journal of Hand Surgery·Justin C HaghverdianNeil G Harness
Mar 30, 2020·The Journal of Hand Surgery·Brian KattPedro Beredjiklian

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Citations

Mar 28, 2021·BMC Musculoskeletal Disorders·Jarosław OlechPiotr Morasiewicz
May 18, 2021·Journal of Hand Surgery Global Online·Amr M TawfikPedro K Beredjiklian

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