COVID-19 could cancel 28 million surgeries

More than 28 million elective surgeries across the globe could be cancelled as a result of the COVID-19 pandemic, leading to patients facing a lengthy wait for their health issues to be resolved. That is according to a new study led by researchers at the University of Birmingham in the United Kingdom and including the University of Cape Town (UCT).

Based on a 12-week stretch of peak disruption to hospital services due to COVID-19, the CovidSurg Collaborative projects that 28.4 million elective surgeries worldwide will be cancelled or postponed in 2020. The modelling study, published in the British Journal of Surgery, 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 of over 5 000 surgeons from 120 countries focused on the impact of COVID-19 on surgical care. This study was led by members based in the United Kingdom, Benin, Ghana, India, Italy, Mexico, Nigeria, Rwanda, Spain, South Africa and the United States.

The researchers collected detailed information from surgeons across 359 hospitals and 71 countries on plans for cancellation of elective surgery. They then modelled the data to estimate totals for cancelled surgery in 190 countries.

The researchers project that worldwide some 72% of planned surgeries would be cancelled through the peak period of COVID-19-related disruption.

Most cancelled surgeries will be for non-cancer conditions. Orthopaedic procedures will be cancelled most frequently, with 6.3 million such surgeries cancelled worldwide over a 12-week period. Globally, 2.3 million cancer surgeries will be cancelled or postponed.

“Patients’ conditions may deteriorate, worsening their quality of life as they wait for rescheduled surgery.”

In South Africa, it is estimated that this will result in over 146 000 cancelled surgeries, including 12 000 cancer procedures. These cancellations will create a backlog that will need to be cleared after the COVID-19 disruption ends.

“Each additional week of disruption to hospital services results in an additional 12 000 surgeries being cancelled,” said Professor Bruce Biccard, second chair in the Department of Anaesthesia and Perioperative Medicine at UCT. “Following the surge in the epidemic, we are going to need a continuous assessment of the situation, so that we can plan a safe resumption of elective surgery at the earliest opportunity.

“Clearing the backlog of elective surgeries created by COVID-19 is going to result in a significant additional cost to the national health department. The government will have to ensure that the national Department of Health is provided with additional funding and resources to ramp-up elective surgery to clear the backlog.”

“During the COVID-19 pandemic, elective surgeries have been cancelled to reduce the risk of patients being exposed to COVID-19 in hospital, and to support the wider hospital response, for example, by converting operating theatres into intensive care units,” commented co-author Aneel Bhangu, consultant surgeon and senior lecturer at the National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery at the University of Birmingham.

“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.”

• CovidSurg Collaborative et al. (2020) Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans. British Journal of Surgery. DOI: 10.1002/bjs.11746