The SWALIS-2020 new model to prioritize elective surgery under the COVID-19 pandemic pressure

Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs New tools are urgently needed Our feasibility-pilot single cohort study assesses a modified Surgical Waiting List InfoSystem (SWALIS-2020) model to prioritize and optimize access to elective surgery throughout and beyond the pandemic (https://www isrctn com/ISRCTN11384058) Materials and Methods: In March-May 2020 we tested a software-aided, inter-hospital, multidisciplinary pathway All specialties elective urgent surgery referrals in the Genoa Metropolitan area have been centralized in the SWALIS-2020 pathway adopting a cumulative linear prioritization method (PAT-2020) by waiting time and clinical urgency categories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression) Results: Following the feasibility phase (N=55 patients), 240 referrals were prioritized in 4 weeks without major criticalities (M/F=73/167, Age=68 7±14 0), waiting lists monitored, and theatres allocated based on the demand The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88 7±45 2 at week 1, then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153 29±103 52) vs A1 (97 24±107 93) (p \u003c0 001), and A3 vs A2 (88 05±77 51) (p \u003c0 001) 222 patients underwent surgery, without related complications or delayed/failed discharges Conclusions: This is an early pilot study However the pathway has smoothly selected the very few patients with the greatest need, optimizing access even with +30% capacity modifications weekly, consistently managing active and backlog waiting lists We are looking for collaboration for further multi-center research to progress through the next pandemic phases Robotic surgery for Abdominal Cancers: How far can we go?