COVID-19-related absence among surgeons: development of an international surgical workforce prediction model
Authors:   COVIDSurg Collaborative, Simoes Joana F F , Li Elizabeth , Glasbey James C , Omar Omar M , Arnaud Alexis P , Blanco-Colino Ruth , Burke Josh , Chaudhry Daoud , Cunha Miguel F , Elhadi Muhammed , Gallo Gaetano , Gujjuri Rohan R , Kaafarani Haytham M A , Lederhuber Hans , Minaya-Bravo Ana , Morton Dion , Pata Francesco , Tsoulfas Georgios , Venn Mary L , Bhangu Aneel , Nepogodiev Dmitri , Omar Omar M , Arnaud Alexis P , Isik Arda , Kaafarani Haytham M A , Kloppers Christo , Lederhuber Hans , McCaul James Anthony , Mehraj Asif , Minaya-Bravo Ana , Mitul Ashrarur R , Moszkowicz David , Mugla Naser , Pata Francesco , Porcu Alberto , Quante Markus , Di Saverio Salomone , Singh Pritam , Solli Piergiorgio , Spinelli Antonino , Townend Philip , van Ramshorst Gabrielle H , Yildiz Alp , Zamvar Vipin , Abbott Tom , Siaw-Acheampong Kwabena , Adamina Michel , Ademuyiwa Adesoji O , Agarwal Arnav , Alameer Ehab , Alderson Derek , Alakaloko Felix , Alser Osaid , Augestad Knut Magne , Ayasra Faris , Bankhead-Kendall Brittany K , Barlow Emma , Benson Ruth A , Blanco-Colino Ruth , Brar Amanpreet , Minaya-Bravo Ana , Breen Kerry A , Buarque Igor Lima , Caruana Edward J , Chaar Moe , Chakrabortee Sohini , Cox Daniel , Cunha Miguel F , Cukier Moises , Davidson Giana H , Dawson Brett E , Desai Anant , Di Saverio Salomone , Drake Thomas D , Edwards John G , Evans Jonathan P , Farik Shebani , Fiore Marco , Fitzgerald J Edward , Ford Samuel , Gallo Gaetano , Ghosh Dhruv , Ataíde Gomes Gustavo Mendonça , Griffiths Ewen A , Gujjuri Rohan R , Halkias Constantine , Harrison Ewen M , Heritage Emily , Hutchinson Peter J , Isik Arda , Jenkinson Michael D , Jones Conor S , Kamarajah Sivesh K , Keller Deborah S , Khatri Chetan , Keatley James M , Kolias Angelos , Lawani Ismail , Lawday Samuel , Leventoglu Sezai , Li Elizabeth , Löffler Markus W , Martin Janet , Mashbari Hassan N , Mazingi Dennis , Mckay Siobhan C , Metallidis Symeon , Minaya-Bravo Ana , Mohan Helen M , Moore Rachel , Moug Susan , Nepogodiev Dmitri , Ng-Kamstra Joshua S , Niquen Milagros , Ntirenganya Faustin , Omar Omar M , Outani Oumaima , Pata Francesco , Pellino Gianluca , Pinkney Thomas D , Pockney Peter , Radenkovic Dejan , Ramos-De la Medina Antonio , Rivera Carlos , Roberts Keith , Roslani April C , Santos Irene , Schache Andrew , Schnitzbauer Andreas A , Stewart Grant D , Shaw Richard , Shu Sebastian , Soreide Kjetil , Spinelli Antonino , Sundar Sudha , Tabiri Stephen , Tiwari Abhinav , Townend Philip , Trout Isobel M , van Ramshorst Gabrielle H , Venn Mary L , Vidya Raghavan , Vimalachandran Dale , Warren Oliver , Wilkin Richard JW , Wright Naomi 
Published: March 2021

Abstract

Background
During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks.

Methods
An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent).

Results
Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19.

Conclusion
This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.