Essential surgery in crisis: A global scoping review of surgical prioritization during the COVID-19 pandemic

A systematic analysis of how essential surgery developed worldwide throughout the COVID-19 pandemic remains absent. This scoping review aims to define essential surgery by comparing definitions between high-income countries and low- and middle-income countries during COVID-19.

We conducted a scoping review of Ovid, PubMed, Scopus, and Web of Science databases for articles published January 2020 to December 2022 that defined essential surgery during COVID-19. Articles referencing pediatric populations or exclusively elective surgery were excluded. This review was registered with PROSPERO (CRD42024495318). Articles were categorized by country income status, surgical specialty, and methodology. Procedures were classified into 8 surgical systems (neurosurgery, breast/gynecology, etc) and deemed to have strong (≥75%), moderate (50-74%), or limited (<50%) consensus as essential on the basis of how many articles mentioned the procedure.

We analyzed 85 articles (61 high-income countries, 24 low- and middle-income countries) from 4,247 screened. Essential surgery comprises procedures needed within 30 days that prevent mortality, are time-sensitive, preserve function, prevent altered prognosis, or have no medical alternatives. Neurosurgery was most represented, with strong consensus for immediate life-threatening conditions needing intervention within 24 hours. Although high-income countries and low- and middle-income countries agreed on procedures addressing immediate threats to life, significant disparities existed in urology, gynecology, and colorectal surgery.

Our findings highlight the need for resource-stratified, specialty-specific guidelines that can be adapted to different health care contexts, while maintaining the core principles of surgical prioritization. Future frameworks should incorporate timeframes for safe surgical delay, risk of disease progression, resource requirements, and expected outcomes to guide ethical surgical triage.