The world was not ready to face a global health crisis. Almost one year after the coronavirus disease 2019 (COVID-19) pandemic emerged in China, more than 67.59 million people have been infected globally.
During the pandemic's peak, health care systems were overwhelmed, and health workers were overworked and at a high risk of contracting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.
Researchers at the University of Calgary, Canada, shed light on how surgical services have been reorganized during and following public health emergencies. They also tackled the consequences of these changes for both patients and healthcare workers.
The coronavirus pandemic
The novel SARS-CoV-2 virus first emerged in Wuhan City, Hubei Province, China, in December 2019. From there, it has spread to over 191 countries and territories. Since the virus has high transmissibility, it has spread rapidly across continents, with many countries imposing travel bans and lockdowns to contain the virus.
During the pandemic's peak, there was a shortage of medical supplies such as personal protective equipment (PPE), face shields, surgical masks, and other medical equipment, leaving many health workers at risk of infection.
Medical institutions have taken steps to maximize staff, PPE, ventilators, and intensive care unit (ICU) capacity if public health efforts to "flatten the curve" are insufficient.
Surgery and COVID-19
Some hospital services, such as the surgical department, have suspended non-urgent or elective surgical procedures. These surgeries are those that can be delayed without adverse effects to the patient.
Without clear instructions on how programs should operate the recommendations to alter surgical service delivery, surgeons and surgical units do not know what to do. As post-pandemic recovery begins, programs will be implemented to rebuild the surgical capacity needed to reschedule and resume the backlog of postponed procedures.
The current study, which was published on the medRxiv* server, aims to better understand how surgical services were reorganized in response to COVID-19 and what steps were taken to resume surgical service delivery.
To arrive at the study findings, the team followed the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist.
The team searched academic databases and grey literature sources to identify studies that examine surgical service delivery during public health emergencies, including the COVID-19 pandemic. They also looked at the impacts on patients, health workers, and healthcare systems.
They collated and reviewed 132 studies, wherein 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services, and six reported actions are taken to rebuild surgical capacity in public health emergencies.
The study findings revealed that the reorganization of surgical services, such as case triage, PPE regulations and practice, outpatient and inpatient care, hospital environment, and workforce composition, had large reductions in non-urgent surgical volumes. Meanwhile, there were increased surgical wait times, impacted surgical and medical training, and negative patient outcomes, such as increased pain.
In conclusion, the team said that rebuilding surgical capacity strategies were rare but focused on workforce availability, PPE, and patient readiness for surgery. They recommend that all these factors should be considered before resuming services.
Reorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood in order to optimize future health system responses to public health emergencies."
The team also discussed the strengths of the study. They said that the rapid scoping review provides a comprehensive summary of the literature regarding modifications to surgical services in response to public health emergencies, such as COVID-19. They did not limit the studies based on location and language to make sure the study tackles the worldwide situation amid the COVID-19 pandemic.
However, the team said that since the COVID-19 pandemic continues to spread, many studies with potential relevance to this review are emerging at an unprecedented rate. Therefore, current studies were not included.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.