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Geographical distribution of SPI score (A) Distribution displayed is centred around the mean value of SPI total score (84·5). Green indicates better prepared surgical systems; red indicates less prepared surgical systems. (B) Distribution of the SPI by country income group. The theoretical score range limits of the SPI were 23-115 points. The lowest mean hospital score was 26 and the highest was 115. These values are displayed at the floor and ceiling values of the x-axis. SPI=surgical preparedness index.
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Background
The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...
Citations
... On the other hand, a competency-based and time-variable (CB-TV) approach has been successfully introduced and re ned GME programs in many countries (e.g., the UK, the Netherlands, Canada), presenting the paradigm shift in the education of the next generation of physicians [41,42]. Our ndings serve as a reference point, underscoring residents' needs and readiness to transition to CB-TV GME to galvanize healthcare systems against future crises [43,44,45,46,47,48]. ...
Background: COVID-19 generated a system-wide shock causing an unbalanced equilibrium be- tween producing adequately trained physicians and meeting extraordinary operational needs. Pre- vious studies report the experience of surgical residents during COVID-19 on a regional level. This study measures the learning losses causally associated with the re-deployment of highly special- ized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies.
Methods: We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents’ expected learning outputs, career prospects and recommended remedial mea- sures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients.
Results: The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents ex- pected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated prior to COVID. Residents in COVID-19 hospitals reported participating in significantly (p < 0.001) fewer surgeries and having significantly (p < 0.001) lower surgical skill relative to those not in COVID-19 hospitals.
Conclusions: The perceived lower competence and the fall-off in surgical skill and scientific knowl- edge among future surgeons suggest that healthcare systems globally may have limited capacity to perform delicate and costly procedures in the future.
... The COVID-19 pandemic impaired resident training across the world. Future epidemics, natural phenomena associated with climate change, geopolitical instabilities also pose a significant threat to resident training in the future [48][49][50]. Our study contributes to a broader understanding of the resilience of each country's resident training programs to crises. ...
... Our approach to quantifying resident learning inputs and expected outputs is general and can be applied in more contexts and specialties. Our measures of learning outputs, in particular, speak to current proposals to develop a ''Surgical Preparedness Index'' (SPI) to assess, monitor, and improve the resilience of training programs and healthcare systems across the world [48]. ...
Background:
The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world.
Methods:
We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons.
Results:
The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006).
Conclusions:
Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement.
Level of evidence v:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Global health has traditionally focused on the primary health development with disease-specific focus such as HIV, malaria and non-communicable diseases (NCDs). As such, surgery has traditionally been neglected in global health as investment in them is often expensive, relative to these other priorities. Therefore, efforts to improve surgical care have remained on the periphery of initiatives in health system strengthening. However, today, many would argue that global health should focus on universal health coverage with primary health and surgery and perioperative care integrated as a part of this. In this article, we discuss the past developments and future-looking solutions on how surgery can contribute to the delivery of effective and equitable healthcare across the world. These include bidirectional integration of surgical and chronic disease pathways and better understanding financing initiatives. Specifically, we focus on access to safe elective and emergency surgery for NCDs and an integrated approach towards the rising multimorbidity from chronic disease in the population. Underpinning these, data-driven solutions from high-quality research from clinical trials and cohort studies through established surgical research networks are needed. Although challenges will remain around financing, we propose that development of surgical services will strengthen and improve performance of whole health systems and contribute to improvement in population health across the world.
Background. This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods. We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign in-tracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients' location by World Bank income groups (high [HIC], upper-middle [UMIC], and low-and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality.
Background:
This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic.
Methods:
We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients' location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality.
Results:
Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37-5.74) compared to HIC.
Conclusions:
The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.
