First nationwide study reveals millions of cancelled operations due to COVID-19 and high risk of death

The analysis, led by Queen Mary University of London and Swansea University Medical School, and funded by Barts Charity, comes at a time when NHS England has paused the collection and publication of official statistics on cancelled operations, and is the first to provide operational detail on surgical activity, and to gauge the true reduction in procedures that occurred across all NHS hospitals during the pandemic.

In the first of two papers published in the British Journal of Anaesthesia, the researchers calculate the overall shortfall will increase to 2.4 million cancelled operations by the end of 2021 with millions more patients feeling the impact for years to come.

Key findings of study into surgical activity

The investigation used hospital and patient data, describing every episode of NHS hospital care in England and Wales during 2020. These statistics were then compared to the surgical activity during the four years prior to the study period.

Across all categories of surgery, there was an overall drop of 33.6 per cent in surgical activity over the year. The largest number of cancelled or postponed operations occurred in semi-urgent surgery with over 900,000 cancelled procedures. The greatest decrease in surgical activity was seen in elective surgery with nearly half a million fewer admissions and more than one in two procedures cancelled.

The researchers calculate the recovery of surgical activity has to date been incomplete, hampered by increased hospital staff sickness, reduced operating room capacity and an enhanced regime of infection controls. This will mean a cumulative shortfall of 2.4 million procedures by the end of the year, the equivalent of more than six months of pre-pandemic surgical activity.

High risk of death in surgery patients with COVID-19

In a separate study, led by Queen Mary and also published in the British Journal of Anaesthesia, the England-wide survey of all NHS surgery patients reveals the high risk of death among patients who acquire COVID-19 during or immediately after their hospital stay.

The analysis found that while only 1.1 per cent of patients acquired the infection at the time of their operation, where patients did succumb to the virus, the mortality rate was extremely high. Overall, surgical patients who became infected with Covid were five times more likely to die within 90 days of their operation.

Patients undergoing elective surgery who became infected were 25 times more likely to die. The authors say these statistics indicate that current infection prevention and control policies are highly effective - but cannot be relaxed.

Co-lead author Dr Tom Abbott from Queen Mary’s William Harvey Research Institute said: “Our study reveals the true impact of the COVID-19 pandemic on surgical care in England and Wales, including both emergency and elective care. The long-term consequence of the disruption is unclear, but we anticipate that for many patients their quality of life will be severely affected.

“The backlog of surgery is likely to take many years to clear, particularly as the speed with which surgical treatments can be delivered is now slowed by infection control procedures. As highlighted by our research, the high mortality amongst patients who acquire Covid-19 at the time of their surgery, indicates that the current procedures and precautions must remain in place to safeguard our patients.”

Co-lead author Dr Tom Dobbs, Swansea University Medical School said: “The interruption of surgical treatment detailed in our research will be felt by millions of patients for many years to come. Delays in the diagnosis and surgical management of cancer patients will lead to an increase in deaths, while those waiting for semi—urgent and elective surgery are likely to experience a worsening of their condition, with some procedures made more problematic and less likely to succeed.

“Our research highlights the urgent need for a major re-organisation of hospital surgical services. We need more financial commitment from central government and tough decisions to be made about which patients should be prioritised for NHS treatment over the coming weeks, months and years.”

More information

• Research paper: “Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study”. British Journal of Anaesthesia. https://doi.org/10.1016/j.bja.2021.05.001
• Research paper: “Mortality after surgery with SARS-CoV-2 infection in England: A population-wide epidemiological study”. British Journal of Anaesthesia. https://doi.org/10.1016/j.bja.2021.05.018