Evaluating essential surgery during COVID-19

Editor's Note

This study led by researchers at the Massachusetts General Hospital, Boston, examines the World Bank Disease Control Priorities’ 44 essential surgical procedures, which are a starting point for health care systems in low- and middle-income countries, and analyzes whether the list should be expanded for nations with more advanced health systems. Curtailing elective surgery for the COVID-19 pandemic offered an opportunity to evaluate and modify the list.

Of 818,985 surgical procedures analyzed, comparing April 2019 (prepandemic baseline) and April 2020 (surgical nadir [lowest point]):

• Overall procedure volume during the nadir decreased by 46.2% compared with baseline.
• Essential procedures during the nadir were 74.4% of total procedures compared with baseline (59.8%).
• Urgent procedures represented a similar proportion of total procedures between periods (nadir 15.5%, baseline 16.2%).
• Nonurgent procedures represented a smaller proportion during the nadir (10.1% vs 24.0%).

Comparison of the three highest frequency procedures showed that:

• Soft-tissue surgery was the most frequent at baseline (38.7%) and nadir (50.7%).
• Nonurgent procedures—bone, muscle, tendon, nerve, or not otherwise categorized (6.3%) and arthroplasty (5.7%)—were the next most frequent at baseline.
• Essential procedures—cesarean delivery (7.2%) and operative fracture treatment (4.7%)—were the next most frequent at nadir.

The combination of urgent surgeries (15.5%) with those on the essential procedures list (74.4%) accounted for 89.9% of procedures performed at nadir.

Results show that not only was there a decrease in total procedure volume during the COVID-19 pandemic, but also a change in the comparative distribution of procedures. The findings of this study suggest that the essential surgical procedures list accurately categorized most essential procedures, the researchers say.