A rapid review of the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity

Abstract

The COVID-19 pandemic further exacerbated disruptions to elective care services in the UK, leading to longer waits for treatment and a growing elective surgery backlog. There have been growing calls for the creation of surgical hubs to help reduce this backlog. Surgical hubs aim to increase surgical capacity by providing quicker access to procedures, as well as facilitate infection control by segregating patients and staff from emergency care. This rapid review aimed to assess the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity, to inform the implementation of these hubs in Wales. The review identified evidence available up until January 2023. Twelve primary studies were included, eight of which used comparative methods. Most of the studies were conducted during the COVID-19 pandemic and described surgical hubs designed mainly to mitigate the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Outcome measures reported included clinical, performance, economic, and patient reported outcomes across a variety of different surgical disciplines. Most of the studies did not describe surgical hubs based on their structure, i.e., standalone, integrated, or ring-fenced hubs. The evidence relating to the impact of surgical hubs on clinical outcomes appeared to be heterogenous and limited. Included studies did not appear to control for the impact of the COVID-19 pandemic on outcomes. Evidence of the impact of surgical hubs on performance outcomes such as efficiency, utilisation/usage, volume of surgeries/treatments, performance, cancellations, and time from diagnosis to treatment is limited. Evidence relating to the economic impact of surgical hubs is also limited, however there is evidence to suggest that total average costs are lower in surgical hubs when compared to general hospitals. Evidence relating to the impact of surgical hubs on patient reported outcomes is limited but indicates there may be a positive effect on patient satisfaction and compliance. Considerable variation in the types of surgical hubs reviewed, surgical disciplines, along with the small number of comparative studies, as well as methodological limitations across included studies, could limit the applicability of these findings.