Rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists
The rapid review sought to examine how positive, innovative interventions might support patients on surgical waiting lists in Wales, and elsewhere, along with improving healthcare delivery. It was conducted by the Wales COVID-19 Evidence Centre following requests from Health Boards and others.
The review aims to help patients on record high elective surgery waiting lists, and inform strategies and policy in managing these lists.
Prolonged waits for surgery can impact negatively on patients who may experience worse health outcomes, poor mental health, disease progression, or even death.
COVID-19 has added numbers to these waiting lists, increasing the potential for adverse outcomes.
UK Health Boards have adopted strategies to address elective surgery waiting lists that include resource pooling, targeting waiting lists and creating ‘green’ areas to continue surgery throughout the pandemic.
With waiting lists critically high, the following categories of interventions were included in the review:
- Exercise interventions
- Education interventions
- Psychological interventions
- Smoking cessation interventions
- Multi-component Interventions (e.g., Exercise & Education)
The review included 48 systematic reviews, covering the period 2014 to 2021, with 23 of these reviews relating to orthopaedic surgery. Other research included cardiac, vascular, abdominal and nonspecific surgery. 17 (of 48) reviews were used to compile the rapid review with three (two ‘exercise’ interventions and one ‘psychological’) regarded as high quality.
Exercise, psychological and smoking pre-operative interventions have some benefit although, generally, their effectiveness cannot be measured against surgical outcomes.
Educational interventions can sometimes be helpful but can also add to anxiety and impact on mental health.
No evidence was identified relating to the current COVID-19 pandemic.
Further research is required:
- to understand how various patient subgroups, particularly those affected by inequality, respond to preoperative interventions.
- on social prescribing or other community-centred approaches.
Policy-makers, educators, and clinicians should consider recommending such interventions to be covered in curricula for health professionals.
Can the NHS transform waiting periods into beneficial preparation periods – moving the emphasis from ‘how long’ to ‘how’ the patient might prepare?
RR00030