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

OBJECTIVES: 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 sear...

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Autores principales: O'Rielly, Connor, Ng-Kamstra, Joshua, Kania-Richmond, Ania, Dort, Joseph, White, Jonathan, Robert, Jill, Brindle, Mary, Sauro, Khara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210688/
https://www.ncbi.nlm.nih.gov/pubmed/34130956
http://dx.doi.org/10.1136/bmjopen-2020-043966
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author O'Rielly, Connor
Ng-Kamstra, Joshua
Kania-Richmond, Ania
Dort, Joseph
White, Jonathan
Robert, Jill
Brindle, Mary
Sauro, Khara
author_facet O'Rielly, Connor
Ng-Kamstra, Joshua
Kania-Richmond, Ania
Dort, Joseph
White, Jonathan
Robert, Jill
Brindle, Mary
Sauro, Khara
author_sort O'Rielly, Connor
collection PubMed
description OBJECTIVES: 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.
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spelling pubmed-82106882021-06-17 Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services O'Rielly, Connor Ng-Kamstra, Joshua Kania-Richmond, Ania Dort, Joseph White, Jonathan Robert, Jill Brindle, Mary Sauro, Khara BMJ Open Surgery OBJECTIVES: 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. BMJ Publishing Group 2021-06-15 /pmc/articles/PMC8210688/ /pubmed/34130956 http://dx.doi.org/10.1136/bmjopen-2020-043966 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Surgery
O'Rielly, Connor
Ng-Kamstra, Joshua
Kania-Richmond, Ania
Dort, Joseph
White, Jonathan
Robert, Jill
Brindle, Mary
Sauro, Khara
Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title_full Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title_fullStr Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title_full_unstemmed Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title_short Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services
title_sort surgery and covid-19: a rapid scoping review of the impact of the first wave of covid-19 on surgical services
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210688/
https://www.ncbi.nlm.nih.gov/pubmed/34130956
http://dx.doi.org/10.1136/bmjopen-2020-043966
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