A new model to prioritize waiting lists for elective surgery under the COVID-19 pandemic pressure

The reduced capacity for routine surgery during the COVID-19 outbreak triggers severe consequences on waiting lists, determining their impressive expansion with management costs. The problem immediately burdens patients with urgent issues and cancer, whose number of avoidable deaths indirectly due to COVID-19 is estimated close to that of SARS-Cov-2. Although several authors and professional associations have proposed clinical prioritization through urgency classifications, pathways and data system models, specific tools are necessary actually to run priority-based scheduling sustainably, in a usable and scalable fashion4. The Surgical Waiting List InfoSystem (SWALIS) has been proposed previously5 with such aims. Here we report on the pilot adoption of a new (SWALIS-2020) model to prioritize elective surgery during the COVID-19 pandemic (https://www.isrctn.com/ISRCTN11384058). This was a feasibility pilot cohort study testing a bespoke software-aided, interhospital, centralized, multidisciplinary pathway serving all major elective urgent surgery from specialties in the Metropolitan area of Genoa with 840 000 inhabitants. The pathway is based on centralized and multidisciplinary team triage of referrals, prioritized further by the SWALIS-2020 model. The SWALIS-2020 model has passed the test, allowing effectiveness, efficiency and equity. These results encourage its wider adoption to prioritize surgery during the COVID-19 pandemic.