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

Abstract

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.

Risk stratification of individuals undergoing surgery after COVID-19 recovery

“…Since 1 January 2021, England and Wales have seen a 38.6% reduction in elective surgery, resulting in more than 1.5 million cancelled emergency and elective operations. 1 As elective surgery resumes, clinicians will be faced with an increasing number of individuals recovering from COVID-19.…”

Global lessons learned from COVID-19 mass casualty incidents

“…In the first waves worldwide this had a major impact on normal processes, as many planned admissions had to be postponed, causing indirect harm to other patients that could not be admitted to the overcrowded intensive care units. 12a More important, it created a shortage of ventilators 13 , as many hospitals in many countries felt they needed to enlarge their critical care services, in particular ventilatory care, expanding beyond the physical boundaries of existing units, including recovery rooms, or even operation rooms. Then the concerns were that care, especially ventilatory care, could become inappropriate, as many extra nurses and doctors were needed at the bedside of the rapidly growing group of critically ill patients that needed invasive ventilation, with many of them having little or even no experience in invasive ventilation.…”

Differential Impact of COVID-19 on Urological Surgeries in Public and Private Institutions at a Nationwide Level: Towards the Day of Reckoning

“…The COVID-19 pandemic disrupted all routine health care services in 2020. To date, the true impact on surgical activities at a nationwide level remains restricted to public UK National Health Service reports [1] , while the consequences for private health care institutions (which are highly involved in providing routine surgical care in many western countries) remain unknown. The context of the French health care system, in which public and private institutions are equally represented, could help to answer this question.…”

“…The context of the French health care system, in which public and private institutions are equally represented, could help to answer this question. Urology can be deemed as a fully relevant model reflecting surgical activity as it is among the top five specialties by volume [1] and has a unique balance in terms of patient gender, patient age, proportion of benign versus malignant diseases, and rates of emergency versus elective surgeries. Moreover, no urological disease or symptom directly linked to COVID-19 has been assessed to date, and all surgical procedures (except for transplantation) can equally be performed in a public or private health care facility.…”