The coronavirus pandemic has led hospitals worldwide to postpone or cancel more than 28 million surgeries, according to the calculation of English researchers.
- Through a questionnaire, surgeons worldwide have informed of the number of operations canceled or postponed.
- In all, 28,404,603, or 72.3% of the interventions planned during the 12 weeks taken into account by the study, are concerned.
- Each new week of hospital disruption leads to the cancellation of 43,300 operations.
- Surgeons will have to make a difficult cost/benefit ratio, depending on the health of patients, for the resumption of operations.
The global pandemic wave continues to flood hospitals around the world with patients infected with Covid-19. A reality that has led countries to adapt their hospital organization, which is reflected in France by the white plan which recommends the postponement of all non-emergency surgical operations. Researchers at the University of Birmingham (UK) have set themselves the goal of counting the exact number of surgeries canceled for 12 weeks in more than 190 countries. The results of this project, entitled COVIDSurgwere published in the journal British Journal of Surgery.
90.2% of canceled operations are benign
A questionnaire was sent to surgeons around the world, through the CovidSurg global network, to estimate the number of elective surgeries canceled in their hospital due to Covid-19. For those practicing in areas where the pandemic has been extinguished, they were required to report actual rates of surgery cancellations. For those practicing in areas where the pandemic was still ongoing, they were projecting likely cancellation rates. If their hospital had not yet experienced a SARS-CoV-2 outbreak, they were asked to estimate what would happen in the event of an outbreak. In total, there were 538 contributions to the questionnaire from 359 hospitals in 71 countries. These data were supplemented by other statistical models to establish the proportions of operations in a total of 193 countries: all members of the United Nations, with the exception of Liechtenstein, North Korea and Somalia , where no data on the volume of surgical operations are available.
Collecting this data allowed the researchers to estimate the number of surgeries canceled during the twelve-week period at 28,404,603, or 72.3% of scheduled surgeries during this period. Among them, the overwhelming majority (90.2%) consists of benign operations. The rest of the operations concern cancers (8.2%) and obstetric interventions (1.6%) which target deliveries by caesarean section which could be replaced by natural deliveries. In detail, 2,367,050 weekly operations are canceled around the world. Brazil is the country with the highest concentration of weekly intervention postponements (247,444), followed by China (326,177), Colombia (113,082), Japan (113,324) and the United States (343 670). In France, 58,708 non-urgent operations are canceled each week.
Postponement of operations can have serious consequences
In a second step, the researchers tried to model the time needed to catch up on all these operations. Their first conclusion is that it is impossible to catch up with them in 12 weeks. “Every additional week of disruption to hospital services results in the cancellation of 43,300 more operationssays Dr. Dmitri Nepogodiev, researcher at the Global Health Research Unit at the University of Birmingham. It is therefore important that hospitals regularly assess the situation so that elective operations can resume as soon as possible..” The time required to perform these procedures, with the exception of obstetric operations which will not need to be rescheduled, depends on the increase in the basic surgical volume. If the latter increases by 10%, the researchers project between 86 and 95 weeks to perform all the postponed operations. If the volume increases by 20%, then it would take between 43 and 48 weeks. With a 30% increase, between 29 and 32 weeks would be needed to catch up.
Regarding the resumption of operations, a cost/benefit ratio according to the health of the patient will have to be carried out by the surgeons and this postponement could have disastrous consequences for certain patients. “Postponing time-sensitive elective operations, such as cancer surgery or transplantation, can lead to deterioration of health, reduced quality of life and preventable deaths. When hospitals resume non-emergency operations, patients are likely to be prioritized for treatment due to clinical urgency, resulting in longer wait times for patients with mild but potentially disabling illnesses, where the impact of time can be less perceived. This will result in deteriorating population health, productivity and significant societal cost”, insist the researchers. “Although essential, cancellations place a heavy burden on patients and society. Patients’ condition may deteriorate and their quality of life declines while they wait for further surgery. In some cases, for example cancer, postponed operations can lead to a number of deaths that could have been avoided”, concludes Aneel Banghu.
