Objectives: As COVID-19 will not be the last pandemic, understanding our historical response allows us to predict and improve our current practices in preparation for the next pandemic. Following the removal of the elective surgery suspension at the onset of the COVID-19 pandemic, it is unclear whether sports medicine surgery volume has returned to pre-pandemic levels as well as whether the BACKLOG from the original suspension was addressed. The purpose of this study to observe the monthly changes in volume and BACKLOG of knee and shoulder sports surgery one year since the original suspension. Methods: National all-payer data was utilized to identify patients undergoing knee and shoulder sports procedures from January 2017 to April 2021. Descriptive analysis was utilized to report the monthly changes in surgeries. A linear forecast analysis using historical data was utilized to determine the expected volume. This was compared to the observed case volume. The difference in expected and observed volume was utilized to calculate the estimated change in BACKLOG. Results: From March to May 2020, there was a persistent decrease in the observed shoulder and knee sports volume when compared to the expected volume. By June 2020, all knee and shoulder sports volume reached the expected volume. By April 2021, the estimated BACKLOG for shoulder and knee procedures had increased by 49. 8% (26, 412 total cases) and 19. 0% (26, 412 total cases), respectively, with respect to the original calculated BACKLOG from March to May 2020. Conclusion: Within four months, the sudden decrease in volume for knee and shoulder sports procedures had returned to pre-pandemic levels,however, the original BACKLOG in cases has continually increased one year following the suspension. Additionally, the BACKLOG is significantly higher for knee when compared to shoulder surgeries. Level of evidence: IV

While there has been overall progress in addressing the lack of access to surgical care worldwide, untreated surgical conditions in developing countries remain an underprioritized issue. Significant BACKLOGs of advanced surgical disease called neglected surgical diseases (NSDs) result from massive disparities in access to quality surgical care. We aim to discuss a framework for a public health rights-based initiative designed to prevent and eliminate the BACKLOG of NSDs in developing countries. We defined NSDs and set forth six criteria that focused on the applicability and practicality of implementing a program designed to eradicate the BACKLOG of six target NSDs from the list of 44 Disease Control Priorities 3rd edition (DCP3) surgical interventions. The human rights-based approach (HRBA) was used to clarify NSDs role within global health. Literature reviews were conducted to ascertain the global disease burden, estimated global BACKLOG, average cost per treatment, disability-adjusted life-years (DALYs) averted from the treatment, return on investment, and potential gain and economic impact of the NSDs identified. Six index NSDs were identified, including neglected cleft lips and palate, clubfoot, cataracts, hernias and hydroceles, injuries, and obstetric fistula. Global definitions were proposed as a starting point towards the prevention and elimination of the BACKLOG of NSDs. Defining a subset of neglected surgical conditions that illustrates society’, s role and responsibility in addressing them provides a framework through the HRBA lens for its eventual eradication.

Background  During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response. Methods  This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis. Results  We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making). Conclusion  This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.

It is important to share demand information among the members in supply chains. In recent years, production and inventory systems with advance demand information (ADI) have been discussed, where advance demand information means the information of demand which the decision maker obtains before the corresponding actual demand arrives. Appropriate production and inventory control using demand information leads to the decrease of inventory and BACKLOG costs. For a single stage system, the optimal base stock and release lead time have been discussed in the literature. In practical production systems the manufacturing system has multiple processes. The multiple stage production and inventory system with ADI, however, has been analyzed by simulation or assuming exponential processing time. That is, their theoretical analysis and optimization of release lead time and base stock level have little been obtained because of its difficulty. In this paper, theoretical analysis of a two-stage production inventory system with advance demand information is developed, where the processing time is assumed deterministic and identical; demand arrival process is Poisson, and an order base stock policy is adopted. Using the analytical results, optimal release lead time and optimal base stock levels for minimizing the average cost on the holding and BACKLOG costs are explicitly derived.