A rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists

Surgical waiting times have reached a record high, in particular with elective and non-emergency treatments being suspended or delayed during the COVID-19 pandemic. Prolonged waits for surgery can impact negatively on patients who may experience worse health outcomes, poor mental health, disease progression, or even death. Time spent waiting for surgery may be better utilised in preparing patients for surgery. This rapid review sought to identify innovations to support patients on surgical waiting lists to inform policy and strategy to address the elective surgical backlog in Wales. The review is based on the findings of existing reviews with priority given to robust evidence synthesis using minimum standards (systematic search, study selection, quality assessment, and appropriate synthesis). The search dates for prioritised reviews ranged from 2014-2021. Forty-eight systematic reviews were included. Most available evidence is derived from orthopaedic surgery reviews which may limit generalisability. The findings show benefits of exercise, education, smoking cessation, and psychological interventions for patients awaiting elective surgery. Policymakers, educators, and clinicians should consider recommending such interventions to be covered in curricula for health professionals. Further research is required to understand how various patient subgroups respond to preoperative interventions, including those from underserved and minority ethnic groups, more deprived groups and those with lower educational attainments. Further research is also needed on social prescribing or other community-centred approaches. It is unclear what impact the pandemic (and any associated restrictions) could have on the conduct or effectiveness of these interventions. Rapid Review Details Review conducted by Public Health Wales Review Team ▪ Dr Chukwudi Okolie ▪ Rocio Rodriguez ▪ Dr Alesha Wale ▪ Amy Hookway ▪ Hannah Shaw Review submitted to the WCEC on 1 st April 2022 Stakeholder consultation meeting 6 th April 2022 Rapid Review report issued by the WCEC in June 2022 WCEC Team ▪ Adrian Edwards, Alison Cooper, Ruth Lewis, Becki Law, Jane Greenwell involved in drafting Topline Summary and editing This review should be cited as RR00030. Wales COVID-19 Evidence Centre. Rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists. April 2022. This report can be downloaded here https://healthandcareresearchwales.org/wales-covid-19-evidence-centre-report-library Disclaimer The views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARY Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Who is this summary for? Health Boards and others involved in planning, monitoring, managing waiting lists for surgery. Background / Aim of Rapid Review Surgical waiting times have reached a record high , in particular with elective and non-emergency treatments being suspended or delayed during the COVID-19 pandemic. Prolonged waits for surgery can impact negatively on patients who may experience worse health outcomes, poor mental health, disease progression, or even death. Time spent waiting for surgery may be better utilised in preparing patients for surgery. This rapid review sought to identify innovations to support patients on surgical waiting lists to inform policy and strategy to address the elective surgical backlog in Wales. The review is based on the findings of existing reviews with priority given to robust evidence synthesis using minimum standards (systematic search, study selection, quality assessment, and appropriate synthesis). Key Findings Extent of the evidence base ▪ 48 systematic reviews were included; 17 reviews were prioritised for inclusion in the narrative synthesis . A further 10 protocols of ongoing systematic reviews were included. ▪ Most reviews (n=23) focused on orthopaedic surgical procedures . ▪ Most reviews (n=31) focussed on exercise-based interventions . Other interventions were educational (n=6), psychological