- •The perspective of maximizing population health, a utilitarian ethical perspective, has been described to be most defendable in times of scarcity. To prioritize patients in need of a surgical procedure, literature mainly discusses approaches that are intradisciplinary (eg, within gynecological or oncological surgery) and mostly consists of narrative reviews of the literature. Some decision tools were developed, which rely on the consensus of experts on various measures of urgency (eg, health benefit, or time until inoperable). No approach was found that transparently weighs objective factors to quantify a clinically relevant measure of urgency.
- •In contrast to previously developed approaches, our approach transparently and consistently aggregates best available objective evidence across disciplines. This novel aggregated urgency measure can be linked with capacity management tools. Our approach can help to minimize health losses when trying to overcome delay in surgical procedures in times of surgical scarcity, during the coronavirus disease 2019 pandemic and beyond.
Ethical considerations for decision making regarding allocation of mechanical ventilators during a severe influenza pandemic or other public health emergency.
- Toner E.
- Waldhorn R.
Patients and Setting
Model Input Parameters
Mortality probabilitys by age, gender, level of education.
Disability-adjusted life years (DALYs).
Time Until No Effect From Surgery
Guideline for conducting economic evaluations in health care.
Guideline for conducting economic evaluations in health care.
Health Effects of Surgery
- Alarid-Escudero F.
- Krijkamp E.M.
- Enns E.A.
- Hunink M.G.M.
- Pechlivanoglou P.
- Jalal H.
|n||Age||Quality of life: preop||Quality of life: postop||Survival: preop||Survival: postop||Time no eff QoL||Time no eff survival||Treatment effect|
|Type of evidence (%)|
|Before-after study||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||1 (4.5)|
|Expert opinion||2 (4.7)||0 (0.0)||0 (0.0)||8 (18.6)||2 (4.7)||5 (83.3)||4 (17.4)||4 (18.2)|
| Expert panel|
|0 (0.0)||29 (67.4)||29 (67.4)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)|
|WHO GBD study||0 (0.0)||14 (32.6)||14 (32.6)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)||0 (0.0)|
|National registry||21 (48.8)||0 (0.0)||0 (0.0)||12 (27.9)||31 (72.1)||0 (0.0)||9 (39.1)||6 (27.3)|
|Observational, Prospective||5 (11.6)||0 (0.0)||0 (0.0)||4 (9.3)||3 (7.0)||0 (0.0)||3 (13.0)||1 (4.5)|
|Observational, Retrospective||10 (23.3)||0 (0.0)||0 (0.0)||9 (20.9)||4 (9.3)||0 (0.0)||7 (30.4)||3 (13.6)|
|RCT||5 (11.6)||0 (0.0)||0 (0.0)||10 (23.3)||3 (7.0)||1 (16.7)||0 (0.0)||7 (31.8)|
|Class of evidence (%)|
|I||5 (11.6)||0 (0.0)||0 (0.0)||10 (23.3)||3 (7.0)||1 (16.7)||0 (0.0)||7 (31.8)|
|IIa||5 (11.6)||0 (0.0)||0 (0.0)||4 (9.3)||3 (7.0)||0 (0.0)||3 (13.0)||2 (9.1)|
|IIb||31 (72.1)||43 (100.0)||43 (100.0)||21 (48.8)||35 (81.4)||0 (0.0)||16 (69.6)||9 (40.9)|
|III||2 (4.7)||0 (0.0)||0 (0.0)||8 (18.6)||2 (4.7)||5 (83.3)||4 (17.4)||4 (18.2)|
- Chen E.Y.
- Mayo S.C.
- Sutton T.
- et al.
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