Difficult recovery from surgery

Difficile reprise des chirurgies

Photo: Jacques Nadeau Le Devoir
According to the government Legault, 68 000 surgeries have been postponed due to the pandemic.

The recovery of the surgery is a real puzzle in the hospitals in Quebec. The activities still run at idle in the operating room, even in regions little affected by the COVID-19, as the Bas-Saint-Laurent, according to the Fédération des médecins spécialistes du Québec. In Montreal, there is a lack of staff, and screening so that the operation rooms are resuming their rhythm, according to doctors consulted by The Duty.

“The delay that has been taken in the surgery will take over a year to catch up, writes Dr. Manon Giroux, head of the department of surgery at the hôpital Pierre-Le Gardeur in Terrebonne. If today, I have a patient who has an inguinal hernia [in the groin], and that it is capable of tolerating it, I’m going to say to him, “think not before one year”. “

The operating block of the hospital, Pierre-Le Gardeur is currently working with three rooms, as compared to eight normally, ” says Dr. Manon Giroux. A fourth will be open on Monday. “But these rooms roll up to 50 % of their capacity, she said. A case that took an hour now takes 2 or 3. “

To avoid contamination COVID-19, several protective measures have been put in place in the operating theatres.

British Columbia anticipates that it will take two years to catch up the delay taken during the pandemic. It was not so much the case that we are waiting.

— Dr. Diane Francoeur

“When intube or extube a patient, it creates fogging and possibly that one place of the virus suspended in the air,” said the D Charles Guertin, head of the department of plasty of the CIUSSS of the Is-de-l’île-de-Montréal, who practice at the Maisonneuve-Rosemont hospital. You should expect that the virus will settle. “

A break of 25 minutes is required before and after surgery, he says.

Valuable time that could be used more effectively, if all patients had a screening test at the COVID-19 before their surgery, ” said Dr Jean-François Courval, president of the Association of anesthesiologists of Quebec. Currently, he says, these patients are considered potentially infected and protection measures are taken accordingly.

“We ask for the two months that we have tests for people that come to theatres,” says Dr. Jean-François Courval. It is done everywhere else in Canada and internationally. “Thanks to routine screening,” it would save time and equipment, ” he says.

Huge amount of work

According to the government Legault, 68 000 surgeries have been postponed due to the pandemic.

“It is in the disorder, said Dr. Diane Francœur, president of the Fédération des médecins spécialistes du Québec (FMSQ). British Columbia anticipates that it will take two years to catch up the delay taken during the pandemic. It was not so much the case that we are waiting. “

In the greater Montreal area, operating rooms run at about 40 % of their capacity, according to Dr. Diane Francœur. The recovery is slower than expected in some areas.

“In Bas-Saint-Laurent and Gaspésie regions, it should be between 70 and 90 % of the business and it is still around 40 %, she said. We do not understand why. “This situation could be explained by the fact that patients prefer not to have surgery, for fear of contracting the coronavirus in the hospital, after it.

This is not to mention that after troismois stop, “recrinquer the machine” takes time, ” observes Dr. Diane Francœur.

Decide which patients will be entitled to surgery in priority represents a huge amount of work, according to Dr. Manon Giroux. Doctors should contact all of their patients to check if their condition has changed. “I have 200 on my list,” she said.

The surgeons then present their case priority to their service (i.e. : orthopedics). Another selection is completed and submitted to a committee who judge of all files, and all specialities within the hospital.

The dashboard on the evolution of the coronavirus in Quebec, in Canada and in the world

This protocol of triage, entitled the ” prioritization system for the access to a surgery in a pandemic situation “, was developed by doctors and ethicists, at the request of the ministry of Health and social Services.

“The system is based on the risk to the health and survival of the person “, says his co-author, Michel Lorange, an ethicist.

The case of urgent or semi-urgent are treated first. But alternative treatments may be offered to patients. “For example, in the case of breast cancer, hormone-dependent, it is possible to give a course of anti-hormone that can delay the progression of the disease and allow us to have a certain waiting period,” said Dr. Serge Legault, who has participated in the drafting of the protocol of triage.

Brigitte Brabant, a lawyer in the field of ethics and health law, is concerned that patients are feeling the effects of such a protocol of triage.

“These people are going to suffer the redevelopment of the list and will be entitled to a care lower than they would have had to have, she thinks. It may mean that people will die and their quality of life will be lower because they have not had a surgery. “

The authors of the protocol to ensure that patients have the right to make ” best care according to their conditions “. The prioritization system, they say, is based on equity.

“If one realizes that the patients are promoted according to their postal code, it will suggest fixes,” said Dr. Serge Legault. We could transfer a patient to another hospital to undergo surgery. “

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