Approaching “Elective” Surgery in the Era of COVID-19

The COVID-19 pandemic created unprecedented challenges for the healthcare system In order to meet capacity demands, hospitals around the world suspended surgeries deemed to be “elective ” In hand surgery, there are numerous pathologies treated on an elective basis, but a delay or absence of care may result in poorer outcomes We present here 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 based on three considerations First, a safe delay is only possible 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, three case examples are discussed taking into account individual patient characteristics and the pathophysiology of the condition This framework design is applicable to ambulatory surgery in any period of crises that may strain resources, but further considerations may be important if an operation requires hospital admission