Gonzalez Kaitlin, Trigo Sabrina, Miller Christine, Urajnik Diana
Northern Ontario School of Medicine, Thunder Bay, ON.
Can Geriatr J. 2021 Mar 2;24(1):73-76. doi: 10.5770/cgj.24.485. eCollection 2021 Mar.
The COVID-19 pandemic has recently put a stop to elective surgical procedures across Canada, inherently compounding already lengthy waitlists that exist within most disciplines of surgery. These long waits for elective procedures within Canadian provinces have not been caused by the COVID-19 pandemic; it is an acute-on-chronic issue that has been exacerbated by the ongoing COVID-19 pandemic. As hospitals begin to reschedule elective surgeries, patients are likely to be prioritized by clinical urgency using both established and newly created surgical triage severity scales. The objective of this commentary is to discuss issues related to the rebooking of elderly surgical patients during the COVID-19 pandemic within the context of northern medicine. Northern and rural hospitals may already face a multitude of barriers related to the rebooking of surgical patients due to a paucity of available surgical resources, as well as difficulties related to accessing care at the local level. While current surgical rebooking tools have been developed in response to the COVID-19 pandemic, they fail to explore certain risks related to the older adult population which may lead to increased mortality and morbidity. Review of the literature indicates that redistribution of surgical resources for older adults in the COVID-19 era will require consideration of clinical medical ethics vs. population health ethics regarding who should be prioritized in re-bookings for elective surgical procedures. This should be done in conjunction with encompassing surgical triage severity scales specifically made for older adults in the time of COVID-19.
新冠疫情最近导致加拿大各地的择期外科手术暂停，这无疑使大多数外科领域本就漫长的等候名单问题更加严重。加拿大各省择期手术的漫长等待并非由新冠疫情导致；这是一个长期存在的问题，因新冠疫情的持续而加剧。随着医院开始重新安排择期手术，患者可能会根据既定的和新制定的手术分诊严重程度量表，按照临床紧急程度进行优先排序。本评论的目的是在北方医学的背景下，讨论新冠疫情期间老年外科患者重新安排手术的相关问题。由于可用手术资源匮乏，以及在当地获得医疗服务存在困难，北方和农村医院在重新安排手术患者时可能已经面临诸多障碍。虽然目前的手术重新安排工具是为应对新冠疫情而开发的，但它们未能探究与老年人群体相关的某些风险，这些风险可能导致死亡率和发病率上升。文献综述表明，在新冠疫情时代，为老年人重新分配手术资源需要考虑临床医疗伦理与群体健康伦理，即对于择期手术重新安排时应优先考虑哪些人。这应结合专门为新冠疫情期间的老年人制定的手术分诊严重程度量表来进行。
