Impact of SARS-CoV-2 on surgical services in a Scottish remote and rural setting

Introduction: The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide, this includes rural settings which had fewer cases of COVID-19 in the first year of the pandemic. In this paper we look at the impact of COVID 19 on the surgical services offered at the Balfour hospital, Orkney Islands, Scotland in the United Kingdom and the impact the pandemic has had  indirectly on the service in 2020.
Method: We performed a retrospective study concentrating on surgical services including emergency hospital presentations and the volume of cancer diagnosis, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital  they are primarily diagnosed by surgeons. We concentrated on the time period between June 2020 – October 2020, in comparison with the previous year, focusing on diagnosis and outcomes. This specific time period was chosen as surgical services reconvened after a period of inactivity due to the COVID 19 pandemic. We looked at the types of emergency admission during this time into the Balfour Hospital and delayed surgeries and the impact of delaying surgery.
Conclusion: Although the effects of COVID-19 have been felt nationwide the impact is more exaggerated in rural communities such as Orkney due to the small population. It is likely the indirect impact on surgical morbidity and mortality in Orkney in 2020 was disproportionately higher than the impact of COVID 19 in the local community. Furthermore, due to limited island resources, there were a significant number of patients requiring transfer to tertiary centers for management of complications. This is a unique issue affecting rural communities.