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

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.