ESSENTIAL SURGERY GUIDELINES DURING COVID-19: TYPES OF SOURCES AND IMPLICATIONS FOR FUTURE SURGICAL PRACTICE aagrawal@mcw.edu

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ESSENTIAL SURGERY GUIDELINES DURING COVID-19: TYPES OF SOURCES AND IMPLICATIONS FOR FUTURE SURGICAL PRACTICE

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Morgan Leissring mleissring@mcw.edu Medical College of Wisconsin Milwaukee United States

Danielle Wilson dwilson@mcw.edu Medical College of Wisconsin Milwaukee United States

Jaclyn VanDerWal jgellings@mcw.edu Medical College of Wisconsin Milwaukee United States

Katherine Iverson kiverson@mcw.edu Medical College of Wisconsin Milwaukee United States

United States

Oral or Poster

Surgical practice changed drastically during the COVID-19 pandemic as healthcare systems faced increased demand and limited resources. Recommendations for essential surgery varied internationally, influencing practice and patient care. This review aimed to identify the sources countries used to define essential surgery to better understand how information was distributed during the pandemic.

A web-based search was conducted using “[country name] essential surgery guidelines covid” in PubMed to identify country-specific guidelines from 2020 to present. Primary literature from general surgery and surgical subspecialties was included.

Guidelines were identified for 25 countries: 17 high-income (HICs) and 8 low- or middle-income countries (LMICs). Thirty-three guidelines were analyzed: 21 from HICs and 12 from LMICs. Sources included international organizations, non-governmental organizations (NGOs), Ministries of Health (MOHs) or other governmental agencies, hospital departments, and professional medical or surgical associations. Only one LMIC, and no HICs, used World Health Organization guidelines. NGO recommendations were used by two HICs and one LMIC. National MOHs guided 5 LMICs and 5 HICs; hospital departments guided 2 LMICs and 2 HICs. Most countries relied on professional associations; specifically, 11 HICs and 7 LMICs. Among these, 3 HICs and 5 LMICs used American College of Surgeons (ACS) recommendations, and 6 LMICs used guidelines from other HICs.

Professional associations supplied most essential surgical guidelines for both HICs and LMICs, with many countries adopting ACS recommendations. Ministries of Health also played key roles in standardizing surgical care. Further work will assess recommendations for emergent versus elective surgeries.