COVID 19: 28 Million Operations Postponed or Cancelled Worldwide

The coronavirus pandemic has caused the postponement or cancellation of more than 28 million surgical operations in hospitals worldwide, according to British researchers.

Surgery

Surgery

The global pandemic continues to flood hospitals around the world with patients infected with COVID-19. This has led countries to adapt their hospital organization with the postponement of all non-essential surgical procedures. Researchers at the University of Birmingham (UK) have set the goal of counting the exact number of surgical operations canceled for 12 weeks in over 190 countries. The results of the project were published in the British Journal of Surgery.

90.2% of the canceled surgeries were minor

Through the Globalsurg global network, a questionnaire was sent to surgeons around the world to estimate the number of elective surgeries that were canceled at their hospitals because of COVID-19. Practitioners in areas where the pandemic has been eradicated were asked to report the actual rate of surgical cancellations. For those practicing in areas where the pandemic was still ongoing, they anticipated that some cancellations were likely. If there had not been an outbreak of SARS-CoV-2 in their hospital, they were asked to estimate what would happen in the event one takes place. A total of 538 answers were received from 359 hospitals in 71 countries. These data were supplemented by other statistical models to determine the proportions of operations in a total of 193 countries: all UN members except Liechtenstein, North Korea, and Somalia, for which no data on the volume of surgical operations are available.

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The collection of these data allowed researchers to estimate the number of surgical interventions canceled during the 12-week period at 28 404 603, or 72.3% of the interventions planned during that period. The great majority (90.2%) of these were minor operations. The remainder were oncological (8.2%) and obstetric (1.6%) surgeries intended for cesarean deliveries that could be replaced by natural births. Specifically, 2,367,050 weekly operations were canceled worldwide. Brazil is the country with the highest concentration of postponements of weekly operations (247,444), followed by China (326,177), Colombia (113,082), Japan (113,324), and the United States (343,670).

Postponement operations can have serious consequences

In a second phase, the researchers tried to model the time needed to catch up on all these procedures. Their first conclusion is that it is impossible to catch up in 12 weeks. “Each additional week of hospital service interruption leads to the cancellation of a further 43,300 operations,” says Dr. Dmitri Nepogodiev, a researcher at the University of Birmingham’s Global Health Research Unit. “It is therefore important that hospitals regularly assess the situation so that elective surgeries can be resumed as soon as possible”. The time needed to perform these operations, with the exception of obstetric surgery, which does not have to be reprogrammed, depends on the increase in basic surgical capabilities. If the basic surgical volume is increased by 10%, researchers forecast 86 to 95 weeks for all the delayed operations. If the volume is increased by 20%, it will take between 43 and 48 weeks. An increase of 30% would only require between 29 and 32 weeks to make up for the delay.

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As far as resuming surgeries is concerned, surgeons must maintain a cost-benefit ratio based on the patient’s health status, and this postponement can have catastrophic consequences for some patients. “Postponement of time-critical elective surgeries such as cancer surgery or transplantation can lead to deterioration in health, reduced quality of life and avoidable deaths”. When hospitals resume non-urgent activities, patients are likely to be given priority treatment because of clinical urgency, resulting in longer delays for patients with benign but potentially disabling diseases where the effects of time may be less noticeable. This will lead to deterioration in public health, productivity, and significant social costs,” the researchers stress. “Although they are essential, cancellations are a heavy burden on patients and society. “Patients may deteriorate and their quality of life may worsen if they wait too long. In some cases, such as cancer, postponed operations can lead to several avoidable deaths,” Aneel Banghu concludes.

References

Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

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