Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study

  1. A J Fowler
  2. T D Dobbs
  3. Y I Wan
  4. R Laloo
  5. S Hui
  6. D Nepogodiev
  7. A Bhangu
  8. I S Whitaker
  9. R M Pearse
  10. T E F Abbott

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Abstract

Background

The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled.

Methods

This was a modelling study using Hospital Episode Statistics data (2014–2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.

Results

A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 – 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.

Conclusion

As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.

Article activity feed

  1. Version published to 10.1093/bjs/znaa012
  2. Version published to 10.1101/2020.06.10.20127266v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.06.10.20127266: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This analysis also has limitations. A series of assumptions were made based on NHS England guidance, which were applied to a series of plausible scenarios regarding the continuation of surgical activity during the pandemic.7, 10 However, the reality of the volume, type and timing of continuation and reintroduction of surgery may differ from these models. The models implemented in this analysis are highly sensitive to the rate and timing of the resumption of surgical care, as evidenced by the much lower cumulative deficit in the sensitivity analysis. It will only be possible to test this in retrospect once actual numbers of procedures carried out are published. Our analysis does not account for lower throughput of surgery due to stricter infection control procedures or a potential second peak of COVID-19.32 Further research is urgently needed to address these issues. It is likely that the volume of emergency surgery that has continued during the pandemic is lower than pre-pandemic levels, perhaps due to patients avoiding hospital or clinicians using alternative management strategies.33 The age distribution of the surgical population is skewed.6 However, due to limitations of the data source, age adjustment in the analysis was not possible. It is likely that, unfortunately, some patients waiting for surgery will have died while waiting to have their surgery. The numbers of these cases are unknown, and it was not possible to account for these in the analysis. It is likely that p...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  4. Version published to 10.1101/2020.06.10.20127266v1 on medRxiv