Clearing the Decks: Covid's lasting impact on Elective Surgery
In my last blog I wrote about a model that was used to predict the number of elective operations that would be cancelled during the first 12-week lockdown in March 20201. The CovidSurge collaborative predicted there would be 28 million operations cancelled globally. That represented 0.4% of the population of the world.
So, how many operations were actually cancelled?
A trawl of the internet reveals that virtually no data has been published. There were many country reports of cancelled operations across the world, but no numbers. Except for England. In February 2021 NHS England (the health system) reported that just under 4.7 million people were waiting for hospital treatment. That is around 8% of the population. This data suggests that the CovidSurge figure was an underestimate. Given that there were further lockdowns throughout 2020 and 2021, the actual number of operations cancelled is likely to be much higher than 28 million.
The CovidSurge collaborative study1 also looked at how long it would take hospitals to clear the backlog of elective surgery. Their analysis suggested it would take an exceptionally long time. This is shown below:
| Increase above baseline surgical volume (%) | Time to clear backlog (weeks) | Time to clear backlog (months) |
|---|---|---|
| 10% | 90 | 21 |
| 20% | 45 | 10 |
| 30% | 30 | 7 |
It could take up to 2 years to clear the backlog. The number of patients waiting for their operation will continue to grow. Many healthcare systems around the world now remind us of the reverse of the leaky bucket analogy, whereby they are trying to empty the bucket, but it keeps filling up.
Remember, behind these statistics people are suffering unnecessarily, people are dying needlessly. It’s clear that hospitals are having to rethink how they carry out elective surgery in an attempt to not only clear the backlog, but also prevent patients becoming infected with Covid-19.
So, what are hospitals doing to prevent elective surgical patients not only coming into hospital with Covid-19 but catching Covid-19 when they are in hospital for their operation?
It all starts with the patient at home. They are expected to self-isolate for up to 14 days and test negative for Covid-19 before they enter hospital. During their time in hospital, no-one would be able to visit them. Many hospitals have set up Covid-19 free operating sites. They are also known as Covid light, cold, or green sites and are either a separate building or area within a hospital. To keep these buildings/sites Covid-19 free involves the following:
Isolating elective patients from others either within the hospital or in a separate building.
Using only staff dedicated to the Covid light area.
Creating a rapid Covid-19 testing facility to provide test results on staff and patients. This still takes 24-48 hours.
Repeated testing of staff.
Enhanced cleaning of Covid-19 light areas.
Even though elective surgery is returning, cancer and heart surgery patients are being prioritised leading to a deterioration in the health of other patients waiting for orthopaedic or plastic surgery. Also, there are still a number of barriers preventing elective surgery returning. In June 2020, the Royal College of Surgeons of England surveyed its members and published a report called “Elective Surgery During Covid-19”2 Respondents stated the main barriers to restarting surgery were:
- Lack of capacity in interdependent services such as diagnostics, anaesthesia, and sterile processing.
- Lack of staff.
- Lack of access to testing for patients, or swift results.
- Lack of sufficient PPE.
In a more recent report, “A New Deal for Surgery” the college made a number of recommendations for dealing with the backlog of elective surgery. These included:
Expanding the number of Covid light sites.
Widen the adoption of a surgical hub model for appropriate specialities such as cancer and orthopaedics.
To put this into perspective, how important is it to ensure that a patient undergoing an operation is Covid-19 free? A study just published in the British Journal of Anaesthesia sheds some light on this.3 The study reported that the incidence of Covid-19 in surgical pathways was very low which suggests current infection prevention and control policies are highly effective. However, those patients who develop Covid-19 are 25 times more likely to die while in hospital.
This blog highlights the need for strong infection prevention and control procedures, particularly during a pandemic. But these measures shouldn’t just be used during a pandemic. They should be the norm.
In summary, it’s going to take a long time to work through the backlog of patients. New surgical Covid light pathways need to be established. More staff have to be recruited. Enhanced infection control must be maintained. These steps are not optional because we must reduce the huge backlog of surgery around the world and at the same time prevent those surgical patients becoming infected with Covid-19.
There is of course a financial cost to all of this, but the money has to be found because patients with Covid-19 infection undergoing surgery have much higher risk of severe postoperative respiratory complications and death. Equipment is a key factor in play to help mitigate the risk of transmission of Covid-19. So, isn’t it time to stop using medical tape on your patient’s eyes in the operating theatre and ICU, removing a potential Covid-19 transmission route and switch to sterile, single use EyePro™, the only sterile eyelid occlusion dressing available. The additional costs for EyePro™ are negligible.
References
Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans COVIDSurg Collaborative. BJS 2020; 107: 1440–1449
Elective Surgery During covid-19. royal College of Surgeons of England. June 2020.
Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study. T. Abbot, A. Fowler, et al. bja.2021.05.018
Author: Niall Shannon, European Business Manager, Innovgas
This article is based on research and opinion available in the public domain.
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