Tribune. At a time when we are experiencing a new wave of the Covid-19 epidemic, alerts are increasing on the sustainability of patient access to critical care (resuscitation services). Our resuscitators and resuscitators as well as forty one hospital crisis directors recently sounded the alarm on the test of patient choice to which they are likely to be increasingly confronted at the start of resuscitation.
We, surgeons, are also faced with a sorting: which patients to deprogram?
According to the stages of the evolution of the epidemic, we receive the order to deprogram already planned interventions, which forces us to select the patients to operate as a priority.
Loss of luck
Our choice is based on the severity and evolution of their disease, but also on the absence of other health problems that could potentially require their passage in intensive care after surgery and therefore occupy a bed that has become so precious. This selection even concerns certain patients requiring surgery for cancer. We then rely on the reflections and recommendations of our learned societies and our ethics committees drafted during the first wave.
We ask for the sanctuarization, at all costs, of a minimum surgical perimeter whatever the epidemic situation.
While a certain number of interventions are not of an emergency nature, the fact remains that the postponement of certain surgeries can lead to a loss of opportunity for these patients who remain on a list waiting to be reprogrammed. .
Each time we close two operating theaters to open resuscitation beds “outside the walls”, this makes it possible to mobilize an anesthetist-resuscitator, two nurse anesthetists and certain operating room nurses trained in critical care to take charge of these additional beds.
Usually, this closure lasts for several weeks. Thus, over a month, this makes it possible to treat eight to twelve patients with severe forms of Covid-19, but in fact leads to the deprogramming of ninety to two hundred operations, depending on the type of surgery usually performed in these closed units. .
Cancers and other diseases
If the pressure on resuscitation is too strong, operating theaters may be reduced to treating only vital emergencies. Few solutions are foreseen to continue a surgical activity making it possible to operate on cancers and other diseases for which surgery may be the most effective treatment. This situation is not acceptable for our patients and we do not want to have to choose between two types of cancer!
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