Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic : systematic review and framework development
(2024) In The British journal of surgery 111(2). p.1-8- Abstract
- Surgical systems are complex and susceptible to external system pressures. The SARS-CoV-2 pandemic and its impact on elective surgery illustrated this. The reassignment of resources to the acute care of patients with COVID-19 led to cancellations of elective services that varied according to surges of the pandemic. Overall, it was estimated that more than 28 million operations were cancelled or postponed globally1. Waiting lists are now a public health crisis, with anticipated impacts on health outcomes, economies, and societies for an undetermined length of time2. For instance, there were approximately 4.3 million patients waiting for surgery in June 2022 in the UK3, and 7.5 million waiting for any elective care in England in June 2023.... (More)
- Surgical systems are complex and susceptible to external system pressures. The SARS-CoV-2 pandemic and its impact on elective surgery illustrated this. The reassignment of resources to the acute care of patients with COVID-19 led to cancellations of elective services that varied according to surges of the pandemic. Overall, it was estimated that more than 28 million operations were cancelled or postponed globally1. Waiting lists are now a public health crisis, with anticipated impacts on health outcomes, economies, and societies for an undetermined length of time2. For instance, there were approximately 4.3 million patients waiting for surgery in June 2022 in the UK3, and 7.5 million waiting for any elective care in England in June 2023. With other factors contributing to more cancellations (for example, climate change, strikes, supply interruptions), the current number is expected to be even higher. Although data are scarce for other countries, similar patterns are expected4,5.
A diverse range of adaptations emerged and were scaled from the beginning of the pandemic to support continuation of elective surgery. Although some existed previously, the pandemic provided a unique opportunity to expand approaches to tackle an anticipated growth in all elective surgery waiting lists. To understand the elective surgical system, using the organizational domains described in the National Surgical, Obstetric and Anaesthetic plan (NSOAP) is extremely helpful6. NSOAP is a policy process and framework used to comprehensively address the health burden of conditions requiring surgery, and includes infrastructure, workforce, service delivery, financing, information management, and governance as domains6,7. Learning adaptations that have been successful will be useful in helping policymakers to decide which strategies would work better in their centre. Adoption of a hub-and-spoke model and performing surgery at weekends are examples of what has been done so far8,9. However, a research gap exists on understanding how these strategies can inform planning of elective surgery after the pandemic2.
The primary aim of this study was to identify and describe the strategies adopted globally that supported continuation of elective surgery and which can support continuation of elective surgery during times of health system stress. The secondary aim was to characterize the strengths and limitations associated with each strategy. (Less)
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- author
- contributor
- Forkman, E.
LU
- author collaboration
- organization
- publishing date
- 2024-01-31
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, SARS-CoV-2, COVID-19/epidemiology, Pandemics, Elective Surgical Procedures, Infection Control
- in
- The British journal of surgery
- volume
- 111
- issue
- 2
- pages
- 1 - 8
- publisher
- Oxford University Press
- external identifiers
-
- pmid:38300731
- ISSN
- 1365-2168
- DOI
- 10.1093/bjs/znad405
- language
- English
- LU publication?
- yes
- id
- a62ae20e-7b3b-4740-8b5e-3b9b409334a8
- date added to LUP
- 2025-04-10 09:43:38
- date last changed
- 2025-04-10 13:10:16
@article{a62ae20e-7b3b-4740-8b5e-3b9b409334a8,
abstract = {{Surgical systems are complex and susceptible to external system pressures. The SARS-CoV-2 pandemic and its impact on elective surgery illustrated this. The reassignment of resources to the acute care of patients with COVID-19 led to cancellations of elective services that varied according to surges of the pandemic. Overall, it was estimated that more than 28 million operations were cancelled or postponed globally1. Waiting lists are now a public health crisis, with anticipated impacts on health outcomes, economies, and societies for an undetermined length of time2. For instance, there were approximately 4.3 million patients waiting for surgery in June 2022 in the UK3, and 7.5 million waiting for any elective care in England in June 2023. With other factors contributing to more cancellations (for example, climate change, strikes, supply interruptions), the current number is expected to be even higher. Although data are scarce for other countries, similar patterns are expected4,5.<br/><br/>A diverse range of adaptations emerged and were scaled from the beginning of the pandemic to support continuation of elective surgery. Although some existed previously, the pandemic provided a unique opportunity to expand approaches to tackle an anticipated growth in all elective surgery waiting lists. To understand the elective surgical system, using the organizational domains described in the National Surgical, Obstetric and Anaesthetic plan (NSOAP) is extremely helpful6. NSOAP is a policy process and framework used to comprehensively address the health burden of conditions requiring surgery, and includes infrastructure, workforce, service delivery, financing, information management, and governance as domains6,7. Learning adaptations that have been successful will be useful in helping policymakers to decide which strategies would work better in their centre. Adoption of a hub-and-spoke model and performing surgery at weekends are examples of what has been done so far8,9. However, a research gap exists on understanding how these strategies can inform planning of elective surgery after the pandemic2.<br/><br/>The primary aim of this study was to identify and describe the strategies adopted globally that supported continuation of elective surgery and which can support continuation of elective surgery during times of health system stress. The secondary aim was to characterize the strengths and limitations associated with each strategy.}},
author = {{Ademuyiwa, AO and Bhangu, A and Chakrabortee, S. and Glasbey, J. and K. Kamarajah, S. K. and Ledda, V. and Li, E. and Morton, D. and Nepogodiev, D. and Picciochi, Maria and Simoes, Joana FF and Lapitan, M. C. and Cheetham, M. and El-Boghdadly, K. and Ghosh, D. and Harrison, E. M. and Hutchinson, P and Lawani, I and Aguilera, M. L. and Martin, J and Meara, JG and Ntirenganya, F and Ramos De-la Medina, A and Tabiri, S}},
issn = {{1365-2168}},
keywords = {{Humans; SARS-CoV-2; COVID-19/epidemiology; Pandemics; Elective Surgical Procedures; Infection Control}},
language = {{eng}},
month = {{01}},
number = {{2}},
pages = {{1--8}},
publisher = {{Oxford University Press}},
series = {{The British journal of surgery}},
title = {{Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic : systematic review and framework development}},
url = {{http://dx.doi.org/10.1093/bjs/znad405}},
doi = {{10.1093/bjs/znad405}},
volume = {{111}},
year = {{2024}},
}