The impact of the COVID-19 pandemic on urological care in Poland - Post-COVID resilience scenarios and recommendations for healthcare system: A national population-based modelling study.

IntroductionOur aim was to assess the time required to recover the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak in 2020 and 2021 in Poland, to indicate the most affected procedures, and to estimate the recovery time after a likely fourth lockdown.Material and methodsThe data aggregates contained the number of patients who underwent specific urological procedures classified in the ICD-9, performed from January 2009 to October 2019, acquired in granulation per month and per single voivodeship, and obtained by healthcare providers such as hospitals, ambulatory units, and primary care facilities. Using the model, we obtained the time required to discharge the excessive load on the healthcare system and the median wait time in the post-lockdown period. We validated the model based on the data aggregates from March to October 2020.ResultsLeaving the capacity of the most affected procedures unaltered, or increasing it by 20%, would not reduce the backlog of patients waiting to receive care after the third lockdown. The consequences of a feasible fourth lockdown would cause the necessity of a post-lockdown increase in capacity by more than 50%.ConclusionsThe availability of the most affected procedures will never achieve the pre-pandemic state without increasing the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak. These procedures require taking special steps to unblock the urological healthcare system and allow patients continuous access to treatment.

Access to burn care in low-and middle-income countries: An assessment of timeliness, surgical capacity, and affordability in a regional referral hospital in Tanzania

This study investigates patients’ access to surgical care for burns in a low-and-middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50 percent reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within three weeks for 74 percent in this group. Of contracture patients, seventy four percent, had sought healthcare after the acute burn injury. Of the same group, only 4 percent had been treated with skin grafts beforehand, and 70 percent never received surgical care or a referral. Combined, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively impacting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socio-economic factors that determine patient mortality and disability.

Assessment of surgical capacity in Chiapas, Mexico: a cross-sectional study of the public and private sector

IntroductionSurgical, anaesthesia and obstetric (SAO) care are essential, life-saving components of universal healthcare. In Chiapas, Mexico’s southernmost state, the capacity of SAO care is unknown. This study aims to assess the surgical capacity in Chiapas, Mexico, as it relates to access, infrastructure, service delivery, surgical volume, quality, workforce and financial risk protection.MethodsA cross-sectional study of Ministry of Health public hospitals and private hospitals in Chiapas was performed. The translated Surgical Assessment Tool (SAT) was implemented in sampled hospitals. Surgical volume was collected retrospectively from hospital logbooks. Fisher’s exact test and Mann-Whitney U test were used to compare public and private hospitals. Catastrophic expenditure from surgical care was calculated.ResultsData were collected from 17 public hospitals and 20 private hospitals in Chiapas. Private hospitals were smaller than public hospitals and public hospitals performed more surgeries per operating room. Not all hospitals reported consistent electricity, running water or oxygen, but private hospitals were more likely to have these basic infrastructure components compared with public hospitals (84% vs 95%; 60% vs 100%; 94.1% vs 100%, respectively). Bellwether surgical procedures performed in private hospitals cost significantly more, and posed a higher risk of catastrophic expenditure, than those performed in public hospitals.ConclusionCapacity limitations are greater in public hospitals compared with private hospitals. However, the cost of care in the private sector is significantly higher than the public sector and may result in catastrophic expenditures. Targeted interventions to improve the infrastructure, workforce availability and data collection are needed.

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

ObjectivesTo 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.DesignA rapid scoping review.SettingWe searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations.ParticipantsStudies 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 measuresPrimary 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.ResultsOne 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.ConclusionsReorganisation 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.