Gaps in Perioperative Healthcare Delivery in the Month Following an Earthquake: A Systematic Review

Introduction: Timely surgical care is key to mitigating earthquake-related morbidity and mortality. However, no comprehensive literature synthesis on post-earthquake perioperative service delivery exists to inform surgical services’ disaster planning. This systematic review aims to identify gaps in healthcare delivery for patients undergoing surgery within a month after an earthquake. Methods: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (CRD42023463920). Databases were searched from 2003 to August 21, 2023. Articles had at least one healthcare delivery gap for patients undergoing surgery within a month post-earthquake. A healthcare delivery gap was defined as instances where the care delivered is discrepant from what should ideally occur. Preliminary descriptive statistics and thematic analysis of healthcare delivery gaps were performed based on the Agency for Healthcare Research and Quality framework. Results: Of the 1391 unique articles retrieved, 137 were included. There were 71 descriptive reports, 45 cross-sectional studies, 12 commentaries or editorials, four mixed-methods studies, 3 case reports, and 2 cohort studies. Twenty-seven different earthquakes in 13 countries were represented, with a minimum moment magnitude scale measurement of 6.1 and a maximum of 9.1. Fifty-three studies (38.7%) described utilizing a field hospital in their post-disaster relief efforts. Twenty-nine (21.2%) studies contained obstetric patients, and 89 (65.0%) studies contained pediatric patients. The most frequently reported surgical subspecialty was orthopedic surgery (83.9%). One hundred twenty-eight (93.4%) studies mentioned gap(s) in capacity, 55 (40.1%) in organizational structure, 12 (8.8%) in finances, 74 (54.0%) in patients, 98 (71.5%) in care processes and infrastructure, and 52 (38.0%) in culture. Conclusion: Capacity was found to be the most impacted perioperative healthcare delivery domain following an earthquake. Findings of this systematic review can inform disaster planning of surgical and perioperative services.