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

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.

Fig. 1

Number of hospital admissions for surgery in England between 1 April 2015 and 31 March 2019, categorized by class of surgery according to NHS England definition Class 1, emergency surgery; class 2, urgent surgery with a waiting time of less than 4 weeks; class 3, semiurgent surgery with a waiting time of less than 3 months; class 4, elective surgery with a waiting time exceeding 3 months. Fifty-six procedure codes had no mean time recorded so were unclassified; these accounted for a total of 73 admissions and were excluded from analysis. OPCS codes used to define surgery are provided in Table S1.

Fig. 2

Estimated number of surgical procedures performed per month between 1 February 2020 and 31 March 2021 compared with expected number based on time-weighted 5-year average between 1 April 2014 and 31 March 2019, and predicted cumulative number of cancellations between 1 February 2020 and 31 March 2021 a Mean estimated number of surgical procedures and expected number based on time-weighted 5-year average between 1 April 2014 and 31 March 2019, with 95 per cent confidence intervals represented by shaded areas. b Predicted cumulative number of cancellations. Class 1, emergency surgery; class 2, urgent surgery with a waiting time of less than 4 weeks; class 3, semiurgent surgery with a waiting time of less than 3 months; class 4, elective surgery with a waiting time exceeding 3 months. This assumes a stepwise reactivation of surgical activity from 1 June 2020 onwards, reaching predicted prepandemic levels of surgical activity by 28 February 2021.

Fig. 3

Estimated number of surgical procedures performed per month between 1st February 2020 and 31st March 2021, stratified by class of surgery. Mean activity is shown with 95 per cent confidence intervals represented by shaded areas. Class 1, emergency surgery; class 2, urgent surgery with a waiting time of less than 4 weeks; class 3, semiurgent surgery with a waiting time of less than 3 months; class 4, elective surgery with a waiting time exceeding 3 months. This assumes a stepwise reactivation of surgical activity from 1 June 2020 onwards, reaching predicted prepandemic levels of surgical activity by 28 February 2021.