Historical Perspective
During the severe acute respiratory syndrome (SARS) pandemic of
2002-2003, surgical care was dramatically impacted around the
world.7-9 In Toronto, a global hotspot of the
pandemic, policies enacted to reduce elective operations and conserve
resources were highly effective: ambulatory and elective inpatient
operations declined 70% and 57% year-over-year, respectively, while
non-elective operations requiring inpatient admission post-operatively
declined less than 10%.9 Similar declines were seen
in Hong Kong, where one academic otolaryngology department had 79%
lower surgical volume and 59% lower outpatient clinic
visits.8 Oncologic surgery was not delineated in these
reports specifically. In less severe viral epidemics, such as the H1N1
influenza epidemic in 2009, oncologic surgery has rarely been targeted
for cancellation. The Japanese experience during the H1N1 epidemic
revealed only a 0.4% increase in cancellation
rates.10
Head and neck oncologic surgery will often be classified as “urgent”
surgery with limited decrease in volume expected under the current
policy restrictions. However, pandemic preparedness plans from the
United States’ Institute of Medicine and the Canadian National Advisory
Committee on SARS and Public Health emphasize adherence to the
three-stage pandemic triage plan with surgical care de-escalation
dictated by the current pandemic stage.9,11 Cancer
surgical care typically would be impacted upon reaching triage level 3
(Table 1). The pandemic plans also recommend use of centralized
committees within healthcare institutions to continually review and make
decisions on de-escalation of services, taking into consideration (a)
consequences to patients, (b) resource requirements, and (c) ability to
provide the necessary resources given altered standards of
care.11 Professional societies are recognized as
critical to guide recommendations within individual surgical
specialties.11 As some head and neck surgical cases
are inevitably canceled, it will also be important to monitor for
growing surgical backlogs, which posed significant financial and
resource hardships on the Canadian system during their recovery from the
SARS pandemic.9