Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies
Authors: O’Rielly Connor M , Ng-Kamstra Joshua S , Kania-Richmond Ania , Dort Joseph C , White Jonathan , Robert Jill , Brindle Mary , Sauro Khara M 
Published: December 2020

ABSTRACTBackgroundHealthcare systems globally have been challenged by the COVID-19 pandemic, necessitating the reorganization of surgical services to free capacity within healthcare systems.ObjectivesTo understand how surgical services have been reorganized during and following public health emergencies, and the consequences of these changes for patients, healthcare providers and healthcare systems.MethodsThis rapid scoping review searched academic databases and grey literature sources to identify studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems. Recommendations and guidelines were excluded. Screening was completed in partial (title, abstract) or complete (full text) duplicate following pilot reviews of 50 articles to ensure reliable application of eligibility criteria.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services and six reported actions taken to rebuild surgical capacity in public health emergencies. Reorganizations of surgical services were grouped under six domains: case selection/triage, PPE regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganizations led to large reductions in non-urgent surgical volumes, increases in surgical wait times, and impacted medical training (i.e., reduced case involvement) and patient outcomes (e.g., 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.ConclusionsReorganization 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.ARTICLE SUMMARYStrengths and limitations of the studyThis rapid scoping review provides an exhaustive and rigorous summary of the academic and grey literature regarding modifications to surgical services in response to public health emergencies, especially COVID-19.This study did not limit studies based on location or language of publication to ensure a worldwide pandemic had contributions from worldwide voices.Both quantitative and qualitative outcomes were included, with a mix of inductive and deductive data abstraction approaches to provide a comprehensive understanding of surgical services during public health emergencies.Studies with potential relevance to this question are emerging at an unprecedented rate in response to the COVID-19 pandemic and as such, some may not be included in the current review.Original protocol for the studyAs requested, the original unpublished protocol for this study is included as a supplementary file.Funding statementThis study did not receive grant from any funding agency in the public, commercial or not-for-profit sectors.Competing interest statementAll authors declare that they have no competing interests in accordance with the International Committee of Medical Journal Editors uniform declaration of competing interests.