The building backlog of NHS elective cases post Covid-19

Macdonald, Nathanael; Clements, Caterina; Sobti, Anshul; Rossiter, Daniel; Unnithan, Ashwin; Bosanquet, Nicholas

doi:10.1002/bjs.11817

Cited by 12 publications

(10 citation statements)

References 3 publications

(3 reference statements)

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“…12 Our analysis was conducted on patients admitted before the first COVID wave hit the United Kingdom, however, studies estimate that during the pandemic, elective surgical activity reduced in England and Wales by 38.6%. 13,14 Consequently, there is a large backlog of patients awaiting elective surgery a proportion of whom are likely to have presented later and/or avoided medical intervention for longer. 13,15 These patients may present with a more 'difficult' gallbladder pathology and consequently greater peri-operative challenges.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Consequently, there is a large backlog of patients awaiting elective surgery a proportion of whom are likely to have presented later and/or avoided medical intervention for longer. 13,15 These patients may present with a more 'difficult' gallbladder pathology and consequently greater peri-operative challenges. 6 Utilizing frequently measured pre-operative factors to predict which cases are more likely to require subtotal rather than complete cholecystectomy can potentially enable surgical teams to undertake more precise pre-operative risk assessment and planning, optimize intraoperative conditions, and inform the patient about the possible outcomes in a more accurate form.…”

Section: Discussionmentioning

confidence: 99%

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Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after the acute presentation

Nada¹,

White²,

Widlund³

et al. 2022

Int Surg J

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Background: Approximately 15% of adults in the United Kingdom (UK) are predicted to have gallstone disease, with about 80% of these having asymptomatic gallstones. Patients with symptomatic gallstone disease are recommended to undergo cholecystectomy. Currently, in the UK approximately 60,000 cholecystectomies are performed. During complex laparoscopic cholecystectomies, surgeons may still need to resort to historic procedures such as an open cholecystectomy (5-10%) or even a cholecystostomy. Alternatively considering a subtotal cholecystectomy has been shown to reduce the need for conversion to an open procedure. The aim of our study is to identify pre-operative factors that would predict the need for a subtotal cholecystectomy.Methods: A retrospective study, over a period of 01 March 2019 to 29 February 2020 was undertaken at one of London’s major tertiary centres. We reviewed all adult patients that had undergone laparoscopic cholecystectomies and subtotal cholecystectomies.Results: 243 patients were included in the study after being vetted through the inclusion and exclusion criteria, 95 males and 148 females. 243 patients were identified initially for elective cholecystectomy. 230 were managed surgically, 208 with a total laparoscopic cholecystectomy, and 22 with subtotal laparoscopic cholecystectomy. 243 patients were identified initially for elective cholecystectomy. 230 were managed surgically, 208 with a total laparoscopic cholecystectomy, and 22 with subtotal laparoscopic cholecystectomy.Conclusions: Age, male sex, body mass index (BMI) greater than 30 kg/m2 patients, previous endoscopic retrograde cholangiopancreatography (ERCP), thickened gallbladder walls, and raised preoperative leucocytosis were associated with a greater risk of patients consented for laparoscopic cholecystectomies to undergo a conversion to a subtotal cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after the acute presentation

Nada¹,

White²,

Widlund³

et al. 2022

Int Surg J

View full text Add to dashboard Cite

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“…Given the prevalence of obesity, delays in access to BMS may contribute to deteriorating population health and higher expenditures. BMS delays of five years, indicative of a growing backlog of elective procedures,[ 29 ] were found to reduce QALYs and cost savings associated with BMS. At the start of the pandemic, it was thought that performing elective procedures would put patients at unnecessary risk of infection with COVID-19 and so many procedures were postponed or cancelled.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of bariatric and metabolic surgery, and implications of COVID-19 in the United Kingdom

Galvain

Patel

Kabiri

et al. 2021

Surgery for Obesity and Related Diseases

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Background People living with obesity have been among those most disproportionately impacted by the COVID-19 pandemic, highlighting the urgent need for increased provision of bariatric and metabolic surgery (BMS). Objectives To evaluate the possible clinical and economic benefits of BMS compared with non-surgical treatment options in the UK, considering the broader impact that COVID-19 has on people living with obesity. Methods A Markov model compared lifetime costs and outcomes of BMS and conventional treatment, from the UK perspective, amongst patients with BMI ≥40 kg/m 2 , or BMI ≥35 kg/m 2 with obesity-related comorbidities (Group A), or BMI ≥35 kg/m 2 with type 2 diabetes mellitus (T2DM; Group B). Inputs were sourced from clinical audit data and literature sources; direct and indirect costs were considered. Model outputs included costs and quality-adjusted life years (QALYs). Scenario analyses whereby patients experienced COVID-19 infection, BMS was delayed by five years, and BMS patients underwent endoscopy were conducted. Results In both groups, BMS was dominant versus conventional treatment, at a willingness-to-pay threshold of £25,000/QALY. When COVID-19 infections were considered, BMS remained dominant and, over 1,000 patients, prevented 117 deaths, 124 hospitalizations and 161 ICU admissions in Group A, and 64 deaths, 65 hospitalizations and 90 ICU admissions in Group B. Delaying BMS by 5 years resulted in higher costs and lower QALYs in both groups compared to not delaying treatment. Conclusions Increased provision of BMS would be expected to reduce COVID-19-related morbidity and mortality, as well as obesity-related comorbidities, ultimately reducing the clinical and economic burden of obesity.

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“…8 Additionally, elective procedures deferred in the summer of 2020 have created a surgical backlog across the world. [9][10][11][12][13][14] One question after the pandemic is how patients, including those impacted by malfunctioning devices, will be given the care they need. Individual facilities will likely bear the responsibility of scheduling missed appointments and procedures.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on Medical Device Reporting and Investigation

et al. 2021

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Introduction The Manufacturer and User Facility Device Experience (MAUDE) database houses medical device reports submitted to the U.S. Food and Drug Administration (FDA). In May 2020, the FDA released guidance about medical device reporting during a pandemic, anticipating delays in reporting and investigating events involving medical devices. Methods We aimed to understand how the COVID-19 pandemic impacted medical device reporting by analyzing reports in the MAUDE database that mention COVID-19. Results From the 816,470 reports submitted between January 1 and July 31, 2020, 3,500 (0.43%) included phrases related to COVID-19. Of these reports, 4.8% (167/3,500) described adverse events during COVID-19 patients’ treatment, and 90.3% (3,161 /3,500) described barriers manufacturers faced investigating malfunctioning devices during the pandemic. 4.9% (172/3,500) of reports were not related to COVID-19. Malfunctions were clinically significant in 85.8% (3,004/3,500) of reports. Discussion Reports indicate challenges some manufacturers had when investigating medical devices during the pandemic. The pandemic made investigating implants uniquely difficult, as restrictions to person-to-person contact limited the type of care patients could receive. Because full-scale investigations into malfunctioning devices may be difficult to perform during the pandemic, safety issues may go unaddressed and result in future harm to patients. Conclusion The COVID-19 pandemic and the myriad of healthcare, travel, and shipping challenges it created impacted how manufacturers reported and investigated medical devices. At the current time, it is unclear how manufacturers will address delayed clinical management of implant devices and other uninvestigated malfunctions after the pandemic and how this will impact patient safety.

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The building backlog of NHS elective cases post Covid-19

Cited by 12 publications

References 3 publications

Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after the acute presentation

Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after the acute presentation

Cost-effectiveness of bariatric and metabolic surgery, and implications of COVID-19 in the United Kingdom

The Impact of COVID-19 on Medical Device Reporting and Investigation

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