Table 1.
Five different phases of the Dynamic Scale for Surgical Activity (DYSSA)
| • Phase I. Almost normal scenario |
| - Census - < 5% COVID-19 related admissions without ongoing urgent necessities |
| - Resources - no impact on hospital resources |
| - Surgical activity: no impact on normal activity |
| • Phase II. Low level alert scenario |
| - Census - 5-25% COVID-19 related admissions to ward and ICU |
| - Resources - no impact on hospital resources but with pandemia alertness in the hospital with appropriate separate triage in the emergency room for respiratory symptoms vs non respiratory symptoms |
| - Surgical activity: activity limited to: |
| ○ Oncology |
| ▪ If an increase in the infection curve is suspected, use phase 3 scenario for oncological surgical activity |
| ○ Urgencies |
| ○ Priority benign pathology |
| ▪ only consider if we are in the de-escalation phase |
| • Phase III. Medium level alert scenario |
| - Census – 26-50% COVID-19 related admissions to ward and ICU |
| - Resources - impact on hospital resources with pandemia alertness in the hospital with appropriate separate triage in the ER for respiratory symptoms versus non respiratory symptoms. ICU beds and wards reserved for COVID-19 patients |
| - Surgical activity: activity limited to: |
| ○ Oncologic patients where a lack of treatment would compromise their 3 months survival |
| ○ Oncologic patients who cannot receive neoadjuvant treatment to slow progression of disease |
| ○ Oncologic patients who will not require prolonged ICU stay |
| ○ Urgent surgery |
| • Phase IV. High level alert scenario |
| - Census – 51-75% COVID-19 related admissions to ward and ICU |
| - Resources – Significant impact on hospital, healthcare workers and ICU beds. |
| - Surgical activity: activity limited to: |
| ○ Urgencies |
| • Phase V. Emergency scenario |
| - Census – >75% COVID-19 related admissions to ward and ICU |
| - Resources – Significant impact on hospital, healthcare workers and ICU beds. Limited ICU and ventilation resources, limited OR resources or a rapid infection increase in the hospital. |
| - Surgical activity: activity limited to: |
| ○ Urgencies where the patient will not survive unless intervened within the next few hours after a preoperative triage is done by the ethics committee. |
ICU: intensive care unit.