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Orthopaedic surgical prioritisation: can it be made fairer to minimise clinical harm?
  1. Karthikeyan P Iyengar1,
  2. Puneet Monga2,
  3. Husam Elbana3,
  4. Bijayendra Singh4
  1. 1 Trauma & Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
  2. 2 Department of Orthopaedics, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
  3. 3 Department of Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
  4. 4 Department of Orthopaedics, Medway NHS Foundation Trust Surgical Services, Gillingham, UK
  1. Correspondence to Mr Karthikeyan P Iyengar, Trauma & Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK; kiyengar{at}

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The current COVID-19 pandemic (SARS-CoV-2) has had a profound effect on the provision of healthcare across the National Health Service (NHS) with suspension of all non-urgent elective surgery including orthopaedic procedures to deal with the surge of in-hospital admissions and reduce viral transmission.1

The COVID-19 surge in January 2021 due to the second wave has led to an unprecedented rise in Consultant-led Referral to Treatment Waiting Times (RTT) with more than 300 000 patients awaiting more than a year for treatment—compared with 1600 before the pandemic began.2

The Federation of Surgical Specialty Associations comprising of 10 Surgical Specialty Associations including the Royal College of Surgeons and British Orthopaedic Association have recently updated the ‘Clinical Guide to Surgical Prioritisation during the Coronavirus Pandemic’ for re-starting non-urgent and orthopaedic care.3 This guidance describes levels of surgical priority, covering all surgical specialties except for obstetrics and gynaecology and ophthalmology (table 1).

View this table:
Table 1

Current representative Clinical Guide to Surgical Prioritisation During the Coronavirus Pandemic—The Federation of Specialty Surgical Associations 2021 and suggestions to minimise clinical harm3

Surgical prioritisation is a decision-making process ranking patient referrals in a particular order based on various criteria with the aim of improving fairness and equity in the delivery of surgical healthcare.4 In a publicly funded NHS deciding who receives which level of care is …

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  • Contributors KPI involved in conceptualisation, literature search, manuscript writing and editing. PM and HE in literature search, manuscript writing and editing. BS involved in review of manuscript, supervision of the project and approved the final draft. All authors read and agreed the final manuscript submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.