As many as 28.4 million surgeries to be canceled worldwide owing to coronavirus pandemic, experts predict
The coronavirus pandemic has led to major disruptions of routine hospital services globally. Researchers now estimate that over 28 million elective surgeries across the world could be canceled as a result of the Covid-19 pandemic, leading to patients facing a lengthy wait for their health issues to be resolved.
Amid the ongoing pandemic, hospitals have reduced or canceled elective surgeries to reduce the risk of patients being exposed to Covid-19 in the hospital and associated postoperative complications. This also preserves personal protective equipment (PPE) supplies to be prioritized for the care of coronavirus patients, and releases ward and critical care beds for surges in Covid-19 patients.
Experts warn that there is a risk that delayed treatment of benign conditions as a result of pandemic-related cancelations will lead to deterioration in individual patients’ conditions, increasing disability and reducing their ability to work. This will also lead to lead to substantial societal costs.
“Although essential, cancellations place a heavy burden on patients and society. Patients' conditions may deteriorate, worsening their quality of life as they wait for rescheduled surgery. In some cases, for example, cancer, delayed surgeries may lead to a number of unnecessary deaths,” says Aneel Bhangu, consultant surgeon and senior lecturer at the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham, in the analysis.
However, worldwide cancellations in elective surgery are currently unquantified. According to experts, few countries have access to real-time data, and even those that do, may experience delays in this information being released due to pressures on the health system. Estimating country-level estimates will provide the best possible baseline data to inform planning for post-pandemic surgical recovery, they explain. Accordingly, this study aimed to estimate the total elective operations that would be canceled or postponed worldwide during 12 weeks of peak disruption of hospital services due to Covid-19.
Based on their analysis, the CovidSurg Collaborative has projected that 28.4 million elective surgeries worldwide will be canceled or postponed in 2020. The modeling study also indicates that each additional week of disruption to hospital services will be associated with a further 2.4 million cancellations.
The CovidSurg Collaborative is a research network focussed on the impact of Covid-19 on surgical care. Over 5,000 surgeons from across 120 countries are participating in the CovidSurg program. The collaborative is leading two cohort studies collecting patient-level surgical outcomes data; currently, data on 7,500 patients have been entered by 440 hospitals worldwide.
The current study was led by CovidSurg Collaborative members based in the UK, US, Benin, Ghana, India, Italy, Mexico, Nigeria, Rwanda, Spain, and South Africa. Led by researchers at the University of Birmingham, the team collected detailed information from surgeons across 359 hospitals and 71 countries on plans for cancellation of elective surgery. This data was then statistically modeled to estimate totals for canceled surgery across 190 countries.
The researchers project that globally, 72.3% of planned surgeries would be canceled through the peak period of Covid-19 related disruption. Most canceled surgeries will be for non-cancer conditions. Orthopedic procedures will be canceled most frequently, with 6.3 million orthopedic surgeries canceled worldwide over a 12-week period. It is also projected that globally 2.3 million cancer surgeries will be canceled or postponed.
“Globally, 28,404,603 (72.3%) operations would be canceled or postponed during the peak 12 weeks of the Covid-19 pandemic. Worldwide, 2,367,050 operations would be canceled per week, with 11 countries canceling more than 50,000 operations per week. Most of the canceled or postponed operations were estimated to be benign surgeries (90.2%, or 25,638,922 surgeries), followed by cancer surgeries (8.2%, or 2,324,070), and obstetrics (1.6%, or 441,611),” says the study published in the British Journal of Surgery.
“The best estimate was that the global 12-week cancelation rates would be 81.7% (25,638,921 out of 31,378,062) for benign surgery, 37.7% (2,324,069 out of 6,162,311) for cancer surgery, and 25.4% (441,611 out of 1,735,483) for obstetrics. Caesarean sections would be canceled or postponed. If countries increase their normal surgical volume by 20% post-pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from Covid-19 disruption,” the findings state.
In the US, for example, the research team projects 4,124,043 canceled operations over peak 12 weeks of disruption due to coronavirus, including 3,791,354 benign procedures, 309,121 cancer surgeries, and 23,568 in obstetrics. These cancellations will create a backlog that will need to be cleared after the Covid-19 disruption ends.
In the UK, the National Health Service advised hospitals to cancel most elective surgeries for 12 weeks. It is estimated that this will result in 519,681 canceled surgeries, including 480,182 benign surgeries, and 36,280 cancer procedures.
“This study demonstrates the major burden of canceled elective surgery due to the coronavirus pandemic. Although a similar proportion of surgery will be canceled across different countries, income settings, and geographic regions, the greatest number of cancelations will be in upper-middle-income countries. Cancer surgery will be prioritized in most settings, with most cancellations relating to surgery for benign conditions, most frequently orthopedics,” say researchers.
The team recommends that future research should be prioritized to identify strategies to mitigate the risk of operating in Covid-19 environments, so that cancelations are minimized.