Elective surgery in the time of COVID-19: a lesson learnt
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ASL Rieti / Università degli studi dell’Aquila (scuola di specializzazione in Igiene e Medicina Preventiva), Italy
ASL Rieti, Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1934
Background and Objective:
The COVID-19 pandemic has placed a significant strain on the Italian healthcare system, in terms of backlogs and deferred elective surgery. The Rieti Hospital (Italy) intents to report how the use of Health Technology Assessments helped to address the problem.

On the basis of analysis conducted, a possibility emerged of placing elective surgeries with the highest priority classes (A and B) and skin-to-skin time < 60 minutes in Emergency Operating Room (EOR), occupying up to a maximum of 50% of the available time. The executable procedures identified were: Urology: trans-urethral bladder resection, trans-urethral prostatic resection, urethral stent, nephrostomy;Vascular surgery: carotid stent;Breast Surgery: quadrantectomy, biopsies;General Surgery: inguinal and umbilical hernioplasty, cholecystectomies;Orthopaedics: removal of means of synthesis;Otolaryngology: micro-laryngoscopy, turbinoplasty, septoplasty. The interventions identified were carried out exclusively by professionals selected on the basis of their performances in 2018 and 2019. In case of concomitant urgency, the activation of the second EOR was scheduled, in order to guarantee urgent surgical treatments in the required time.

Despite a reduction in the hours of availability of the EORs (from 144 hours in 2019 to 72 hours in 2020 and 96 hours in 2021), the number of surgeries switched from 4811 in 2019 to 3879 in 2020 and 4342 in 2021, thus increasing the index obtained by comparing the number of interventions on the hours of availability of the EOR.

The rational use of the EOR contained the reduction of interventions determined by the trend of the SARS-CoV-2 pandemic, guaranteeing the execution of class A and B interventions within the times required by the legislation.