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

This rapid review was conducted as part of the Evidence Service’s collaboration with Heath and Care Research Wales

Next update: Update not planned

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Introduction

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.

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.

The review aims to help patients on record high elective surgery waiting lists, and inform strategies and policy in managing these lists.

Main points

How up to date is this evidence?

Searches were conducted in 2022, and we included evidence covering the period of 2014 to 2021.

What We Found?

We included 48 systematic reviews, 23 of which related to orthopaedic surgery. Other research included cardiac, vascular, abdominal and nonspecific surgery.

• 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.

What This Means?

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?

Technical information

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.

Glossary

Rapid review: Is a form of evidence synthesis that accelerates the process of conducting a traditional systematic review to produce evidence in a time-sensitive manner, usually to inform urgent healthcare decisions.

Systematic review: A review that summarises the evidence on a clearly formulated review question according to a predefined protocol, using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, analyse, collate and report their findings. It may or may not use statistical techniques, such as meta-analysis