Ethical Surgical Triage of Head and Neck Cancer Patients during the COVID-19 Pandemic

BACKGROUNDCoronavirus 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.METHODSAn 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.RESULTSHundreds 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.CONCLUSIONSWe describe the use of actively managed surgical triage to fairly balance our patient’s health with public health concerns.