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

Abstract

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

Routine postoperative noninvasive respiratory support and pneumonia after elective surgery: a systematic review and meta-analysis of randomised trials

“…Consequently, there may be enthusiasm to use noninvasive respiratory support in the perioperative setting as an intervention to prevent or reduce postoperative respiratory failure when the disruption to surgery caused by the pandemic eases. 3,9,11,30 Although there is some evidence to support the use of HFNO or NIV to prevent or delay tracheal intubation and invasive mechanical ventilation in patients with hypoxic respiratory failure, the results of this systematic review do not support the routine use of noninvasive respiratory support in the postoperative period in order to prevent respiratory complications. 31e35 The safety and efficacy of noninvasive respiratory support to prevent postoperative respiratory failure among patients with SARS-CoV-2 infection remains unknown.…”

Indirect effects of the pandemic: highlighting the need for data-driven policy and preparedness

“…6 We also observed declines in urgent referrals for cancer by over 70% and for chemotherapy attendances by over 40% in the early first wave. 7 Similar declines have been shown across surgical and endoscopic procedural activity, 8,9 facilitating projections of the burden of missed care, and informing strategies for staffing, resources and policy to address the impact of indirect effects. Relevant healthcare data are already gathered as part of standard care or performance metrics.…”

Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England

“…The COVID-19 pandemic has had a major impact on surgical provision worldwide as ventilators, hospital space, and personnel were redeployed 3 , and international guidelines increased thresholds for emergency surgery 4 . In the National Health Service (NHS) in England, about one-third of the expected surgical procedures in 2020 were cancelled or postponed 5 . For healthcare commissioners to improve care provision during COVID-19 and future pandemics, evidence is required on the collateral (indirect) effects of delaying or cancelling surgery 6–8 .…”