Rathnayake Dimuthu, Clarke Mike, Jayasinghe Viraj
UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, University College Dublin, Dublin, Ireland.
Centre of Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Hosp Pract (1995). 2025 Feb;53(1):2435802. doi: 10.1080/21548331.2024.2435802. Epub 2024 Dec 3.
Long waiting times for elective surgery reflect not just backlog issues but systemic inefficiencies that disrupt the smooth flow of patients through the surgical care pathway. This systematic review adopts a holistic approach to summarize global policies, strategies, and interventions aimed at reducing elective surgery wait times.
A comprehensive electronic search was performed in PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library from December 2019 to January 2020 and updated in April 2022. Eligible studies, published after 2013, focused on waiting lists for major elective surgeries in adults, excluding cancer-related surgeries. Both randomized and non-randomized studies and systematic reviews were included. Study quality was assessed using ROBINS-I, AMSTAR 2, and CASP tools, as appropriate. The review was registered in PROSPERO (CRD42019158455) and reported using a PRISMA flow diagram.
From 7543 records, 92 articles met the inclusion criteria. Evidence was categorized into seven strategic areas: referral management, patient prioritization, preventing scheduled surgery cancellations, perioperative time management, quality improvement methods for surgical care pathways, and waiting time targets for hospitals. Strategies such as referral management, patient prioritization, and preventing cancellations had the most significant impact on reducing waiting times, while perioperative time management and waiting time targets proved less effective.
The review highlights that targeted interventions at different stages of the surgical care pathway yield variable impacts on overall waiting times. While individual measures had limited effects, combining multiple short-term strategies may be more beneficial, particularly for health systems recovering from the COVID-19 pandemic.
择期手术的长时间等待不仅反映了积压问题，还反映了系统效率低下，这些问题扰乱了患者在手术治疗路径中的顺畅流动。本系统评价采用整体方法，总结旨在减少择期手术等待时间的全球政策、策略和干预措施。
于2019年12月至2020年1月在PubMed、EMBASE、SCOPUS、Web of Science和Cochrane图书馆进行了全面的电子检索，并于2022年4月更新。纳入2013年后发表的符合条件的研究，重点关注成人重大择期手术的等候名单，不包括癌症相关手术。纳入随机和非随机研究以及系统评价。根据情况使用ROBINS-I、AMSTAR 2和CASP工具评估研究质量。该评价在PROSPERO（CRD42019158455）中注册，并使用PRISMA流程图进行报告。
从7543条记录中，92篇文章符合纳入标准。证据分为七个战略领域：转诊管理、患者优先级确定、防止预定手术取消、围手术期时间管理、手术治疗路径的质量改进方法以及医院的等待时间目标。转诊管理、患者优先级确定和防止取消等策略对减少等待时间的影响最为显著，而围手术期时间管理和等待时间目标的效果较差。
该评价强调，在手术治疗路径的不同阶段进行有针对性的干预对总体等待时间产生不同的影响。虽然个别措施效果有限，但结合多种短期策略可能更有益，特别是对于从COVID-19大流行中恢复的卫生系统。
