COVID-19: Guidance on triage of 'non-emergent' surgical operations

Dear Members,

 In light of the recent escalation of the COVID-19 outbreak in Malaysia, the College of Surgeons, Academy of Medicine of Malaysia (CSAMM) would like to provide the following guidance on the triage of `non-emergent' surgical operations.

 The re-deployment of staff and resources towards managing the outbreak has limited delivery of elective surgeries. Nevertheless, CSAMM is of the opinion that deferring all elective surgeries risks progression of disease states that will present further down the line with more complexity and worse outcomes.

 In rationalizing the use of limited resources, the following should be considered:

  1. Surgical case-mix:

Surgeries can be categorized according to the urgency of surgery as per the Perioperative Mortality Review (POMR) Guidelines: Prioritization of Cases for Emergency and Elective Surgery (2nd Revision) 2018. As an example, hospitals may choose to concentrate resources on emergencies and category one electives.

  The POMR Guidelines can be accessed via this link.

2. Hospital capacity:

Consideration should be given to the available resources: human resources, facilities, equipment and consumables. Designated COVID-19 hospitals may not be able to support all elective cases, in particular those that require post-operative intensive care or significant use of blood products.

3. Balance of risks:

Surgeons, in consultation with anaesthetic and nursing colleagues, should weigh the risks of proceeding (exposure, lack of resources) against those of deferment (progression of disease, worse patient outcomes). Hospital-wide policies should be fluid, and guided by emerging data.

Further guidance can be obtained from the American College of Surgeons website:

Prof Dr April Camilla Roslani         
College of Surgeons
Academy of Medicine of Malaysia


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