Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines

Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines

Can J Surg 2021;64(1):E103-E107 | PDF

Marie-Eve Bouthillier, PhD; Michel Lorange, PhD; Serge Legault, MD; Lucie Wade, MSc; Joseph Dahine, MD; Jean Latreille, MD; Isabelle Germain, MD; Roger Grégoire, MD; Patrick Montpetit, MD; Catherine Prady, MD; Elise Thibault, MD; Vincent Dumez, MSc; Lucie Opatrny, MD


In many countries, health care institutions have ramped down nonemergent activities in order to free up hospital and critical care beds in anticipation of a wave of patients with coronavirus disease 2019 (COVID-19). Medical activities were reduced to a minimum, leaving operating rooms to run semiurgent and urgent surgeries only. The status quo of systematically prioritizing resources away from surgical care to patients with COVID-19 may lead to unintended long-term outcomes. We propose a 4-step prioritization system based on resource availability and clinical criteria, as well as supplemental triage criteria for instances where multiple patients have equal claims to priority. The algorithm aims to guide clinicians and decision-makers toward allocating resources to surgical patients while still optimizing pandemic-specific benefits to the population.

Accepted January 12, 2021

Affiliations: From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Bouthillier, Dumez); the Centre intégré de santé et de services sociaux de Laval, Laval, Que. (Lorange, Dahine, Montpetit); the Ministère de la Santé et des Services Sociaux, Que. (Legault, Latreille, Opatrny); McGill University Health Centre, Montréal, Que. (Wade); the National Radiation Oncology Committee, Que. (Germain); the Centre Hospitalier Universitaire de Québec, Québec, Que. (Grégoire); the National Breast Cancer Committee (Prady); the Quebec Association of Vascular and Endovascular Surgery (Thibault); the Centre Hospitalier Universitaire de Montréal, Montréal, Que. (Dumez).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See:

DOI: 10.1503/cjs.022220

Correspondence to: M.E. Bouthillier, Faculty of Medicine, Université de Montréal, C. P. 6128, succursale Centre-ville, Montréal, QC H2R 2G7,