The impact of COVID‐19 on anaesthesia and critical care services in the UK: a serial service evaluation*

Abstract

Summary Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID‐19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri‐operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one‐quarter of all surgical activity was lost, with paediatric and non‐cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one‐third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three‐quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID‐19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics.

The need for safe, stable and sustainable resumption of planned surgery in an era of COVID‐19

“…The pandemic has had a significantly deleterious effect on surgical capacity. The Anaesthesia and Critical Care Covid-19 tracking (ACCC Track) survey [3] showed significant disruption to peri-operative care in two-thirds of hospitals and severe disruption in one quarter. Compared with the corresponding period in 2019, one out of five operating theatres were closed and in those that were open, activity was most commonly around 75% of normal.…”

Changes in Healthcare Provision During Covid-19 and Their Impact on Children With Chronic Illness: A Scoping Review

“…In the most overwhelmed parts of the country, paediatric surgery fell to 12–20% of normal activity. 24 These reductions significantly impacted the care of children with epilepsy. Between April – Sept 2020 surgical activity for epilepsy was limited or stopped entirely.…”

Pre‐operative SARS‐CoV‐2 testing, isolation, vaccination and remote prehabilitation – the road to ‘COVID‐19 secure’ elective surgery

“…At best, it asks questions of the need to isolate patients for the full 14 days as compared with 3 days, especially in combination with pre‐operative SARS‐CoV‐2 testing and vaccination [ 12 , 13 ]. This will provide flexibility as we strive to clear the backlog of operations that have been cancelled due to the pandemic [ 14 , 15 ]. For patients who isolate, there must be renewed focus on home prehabilitation.…”