Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

  1. Connor O'Rielly
  2. Joshua Ng-Kamstra
  3. Ania Kania-Richmond
  4. Joseph Dort
  5. Jonathan White
  6. Jill Robert
  7. Mary Brindle
  8. Khara Sauro

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Abstract

To understand how surgical services have been reorganised during and following public health emergencies, particularly the first wave of the COVID-19 pandemic, and the consequences for patients, healthcare providers and healthcare systems.

Design

A rapid scoping review.

Setting

We searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations.

Participants

Studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems were included.

Primary and secondary outcome measures

Primary outcomes were strategies implemented for the reorganisation of surgical services. Secondary were the impacts of reorganisation and resuming surgical services, such as: adverse events (including morbidity and mortality), primary care and emergency department visits, length of hospital and ICU stay, and changes to surgical waitlists.

Results

One hundred and thirty-two studies were included in this review; 111 described reorganisation of surgical services, 55 described the consequences of reorganising surgical services; and 6 reported actions taken to rebuild surgical capacity in public health emergencies. Reorganisations of surgical services were grouped under six domains: case selection/triage, personal protective equipment (PPE) regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganisations led to large reductions in non-urgent surgical volumes, increases in surgical wait times and impacted medical training (ie, reduced case involvement) and patient outcomes (eg, increases in pain). Strategies for rebuilding surgical capacity were scarce but focused on the availability of staff, PPE and patient readiness for surgery as key factors to consider before resuming services.

Conclusions

Reorganisation 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 optimise future health system responses to public health emergencies.

Article activity feed

  1. Version published to 10.1136/bmjopen-2020-043966
  2. ScreenIT

    SciScore for 10.1101/2020.12.03.20243592: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationStudy Selection: Titles and abstracts were reviewed by one of two independent reviewers with a third, independent reviewer screening 25% of randomly selected references in duplicate.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    & Other Non-Indexed Citations) and Embase from inception until May 8, 2020.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    While this study has several strengths, including a comprehensive search of academic and grey literature sources, and a mix of inductive and deductive data abstraction approaches, there are some limitations that should be considered when interpreting our findings. We modified the Joanna Briggs methodology for scoping reviews,5 according to the World Health Organization and Cochrane’s guidance on conducting rapid reviews,7,8 with the intent of balancing rigor with a timely and policy-responsive review of the literature. Also, given that the evidence around the COVID-19 pandemic is growing at an unprecedented rate, it is possible that additional studies have been published since we ran our search strategy, especially around resuming surgical services. In order to mitigate this limitation, an ongoing effort to pivot this study into a living review is underway to ensure the data presented is up-to-date. Notably, this review did not identify evidence from any low or middle-income countries who may face unique challenges during a pandemic compared to high income countries described in our review. It is also likely that during the global pandemic, many healthcare institutions have been focused on coping with COVID-19 instead of publishing their experiences; we hope more organizations will add their experience to the literature. In conclusion, we report early evidence of the operational changes that have occurred internationally in response to public health emergencies which could in...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.03.20243592v1 on medRxiv