Gabriel Liu, Jun-Hao Tan, Hwee Weng Dennis Hey, Leok Lim Lau, Joseph Thambiah, Naresh Kumar, Jonathan Tan, John Ruiz, Vincent Nga, Sein Lwin, Kejia Teo, Chou Ning, Rohit Vijay Agrawal, Bryan NG, Weng Hoa Wong, Tseng Tsai Yeo, Hee-Kit Wong

May 2021, Volume 30, Issue 5, pp 1247 - 1260 Original Article Read Full Article 10.1007/s00586-020-06679-y

First Online: 02 January 2021


During the Coronavirus disease 2019 outbreak, while healthcare systems and hospitals are diverting their resources to combat the pandemic, patients who require spinal surgeries continue to accumulate. The aim of this study is to describe a novel hospital capacity versus clinical justification triage score (CCTS) to prioritize patients who require surgery during the “new normal state” of the COVID-19 pandemic.


A consensus study using the Delphi technique was carried out among clinicians from the Orthopaedic Surgery, Neurosurgery, and Anaesthesia departments. Three rounds of consensus were carried out via survey and Webinar discussions.


A 50-points score system consisting of 4 domains with 4 subdomains was formed. The CCTS were categorized into the hospital capacity, patient factors, disease severity, and surgery complexity domains. A score between 30 and 50 points indicated that the proposed operation should proceed without delay. A score of less than 20 indicates that the proposed operation should be postponed. A score between 20 and 29 indicates that the surgery falls within a grey area where further discussion should be undertaken to make a joint justification for approval of surgery.


This study is a proof of concept for the novel CCTS scoring system to prioritize surgeries to meet the rapidly changing demands of the COVID-19 pandemic. It offers a simple and objective method to stratify patients who require surgery and allows these complex and difficult decisions to be unbiased and made transparently among surgeons and hospital administrators.

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