Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies

Gibson

et al. 2021

Preprint

ObjectivesTo report the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic.Design and settingAnalysis of electronic health record data from the National Health Service (NHS) in England and Wales.MethodsWe used hospital episode statistics for all adult patients undergoing surgery between 1st January 2020 and 31st December 2020. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from the years 2016-2019 with the actual number of procedures in 2020. We estimated the cumulative number of cancelled procedures by 31st December 2021 according patterns of activity in 2020.ResultsThe total number of surgical procedures carried out in England and Wales in 2020 was 3,102,674 compared to the predicted number of 4,671,338. This represents a 33.6% reduction in the national volume of surgical activity. There were 763,730 emergency surgical procedures (13.4% reduction), compared to 2,338,944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1,568,664. We estimate that this will increase to 2,358,420 by 31st December 2021.ConclusionsThe volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in over 1,568,664 cancelled operations. This deficit will continue to grow in 2021.Summary boxesWhat is already known on this topicThe COVID-19 pandemic necessitated a rapid change in the provision of care, including the suspension of a large proportion of surgical activitySurgical activity has yet to return to normal and has been further impacted by subsequent waves of the pandemicThis will lead to a large backlog of casesWhat this study adds3,102,674 surgical procedures were performed in England and Wales during 2020, a 33.6% reduction on the expected yearly surgical activityOver 1.5 million procedures were not performed, with this deficit likely to continue to grow to 2.3 million by the end of 2021This deficit is the equivalent of more than 6 months of pre-pandemic surgical activity, requiring a monumental financial and logistic challenge to manage

Section: Discussionmentioning

confidence: 99%

Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study

Gibson

et al. 2021

Preprint

“…23 Furthermore, these patients are 500 000 400 000 300 000 200 000 Number of surgical admissions 100 000 0 2 500 000 2 000 000 likely to suffer worsening of their physical and mental health whilst while on the waiting list, placing additional burdens on primary and social care, reducing their productivity in the workplace. 24 This represents a huge financial and human cost to society. Dealing with the backlog of surgery will be a challenge to many health systems worldwide.…”

Section: Discussionmentioning

confidence: 99%

“… 23 Furthermore, these patients are likely to suffer worsening of their physical and mental health whilst while on the waiting list, placing additional burdens on primary and social care, reducing their productivity in the workplace. 24 This represents a huge financial and human cost to society.…”

Section: Discussionmentioning

confidence: 99%

Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study

Gibson

British Journal of Anaesthesia

et al. 2021

Self Cite

Background: A significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. Methods: We used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021. Results: The total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740e5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066e2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587e3 100 808) up to December 31, 2021. Conclusions: The volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021.

“…14 To test for associations between SARS-CoV-2 infection and in-hospital mortality we used multivariable logistic regression analysis including the following covariates: age, sex, Charlson co-morbidity index, IMD, presence of cancer, surgical procedure type and admission acuity. 15-18 Results are presented as n (%), mean (SD), median (IQR) or as odds ratios (OR) with 95% confidence intervals and p-values. The threshold for statistical significance was p<0.05.…”

Section: Methodsmentioning

confidence: 99%

Mortality after surgery with SARS-CoV-2 infection in England: A population-wide epidemiological study

Abbott

et al. 2021

Preprint

Objectives: To confirm the incidence of perioperative SARS-CoV-2 infection and associated mortality after surgery. Design and setting: Analysis of routine electronic health record data from National Health Service (NHS) hospitals in England. Methods: We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between 1st January 2020 and 31st October 2020. The exposure was SARS-CoV-2 infection defined by ICD-10 codes. The primary outcome measure was 90-day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson co-morbidity index, index of multiple deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals. Results: We identified 1,972,153 patients undergoing surgery of whom 11,940 (0.6%) had SARS-CoV-2. In total, 19,100 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 2,618/11,940 [21.9%] vs No SARS-CoV-2: 16,482/1,960,213 [0.8%]; OR: 5.8 [5.5-6.1]; p<0.001). Amongst patients undergoing elective surgery 1,030/1,374,985 (0.1%) had SARS-CoV-2 of whom 83/1,030 (8.1%) died, compared with 1,092/1,373,955 (0.1%) patients without SARS-CoV-2 (OR: 29.0 [22.5-37.3]; p<0.001). Amongst patients undergoing emergency surgery 9,742/437,891 (2.2%) patients had SARS-CoV-2, of whom 2,466/9,742 (25.3%) died compared with 14,817/428,149 (3.5%) patients without SARS-CoV-2 (OR: 5.7 [5.4-6.0]; p<0.001). Conclusions: The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.