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Ethical Surgical Triage of Head and Neck Cancer Patients during the COVID-19 Pandemic
  • Francisco J. Civantos MD FACS
Francisco J. Civantos MD FACS
University of Miami Miller School of Medicine
Author Profile

Abstract

BACKGROUND
Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami hospital system COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.
METHODS
An otolaryngologic triage committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for non-surgical options. Patients were tested twice for Sars-CoV-2 before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.
RESULTS
Hundreds of surgeries were cancelled. Sixty-five cases supervised over three weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of Covid-19 exposure tempered these discussions.
CONCLUSIONS
We describe the use of actively managed surgical triage to fairly balance our patient’s health with public health concerns.