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Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study.
Br J Anaesth. 2021 08; 127(2):196-204.BJ

Abstract

BACKGROUND

A significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic.

METHODS

We used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021.

RESULTS

The total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740-5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066-2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587-3 100 808) up to December 31, 2021.

CONCLUSIONS

The volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021.

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Authors+Show Affiliations

Dobbs TD
Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK. Electronic address: tomdobbs@doctors.org.uk.
Gibson JAG
Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.
Fowler AJ
William Harvey Research Institute, Queen Mary University of London, London, UK.
Abbott TE
William Harvey Research Institute, Queen Mary University of London, London, UK.
Shahid T
William Harvey Research Institute, Queen Mary University of London, London, UK.
Torabi F
Population Data Science, Swansea University Medical School, Swansea, UK.
Griffiths R
Population Data Science, Swansea University Medical School, Swansea, UK.
Lyons RA
Population Data Science, Swansea University Medical School, Swansea, UK.
Pearse RM
William Harvey Research Institute, Queen Mary University of London, London, UK.
Whitaker IS
Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK.

MeSH

AdultAgedCOVID-19Cohort StudiesElective Surgical ProceduresEnglandFemaleHospitalizationHumansMaleMiddle AgedPandemicsState MedicineWales

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

34148732

Citation

Dobbs, Thomas D., et al. "Surgical Activity in England and Wales During the COVID-19 Pandemic: a Nationwide Observational Cohort Study." British Journal of Anaesthesia, vol. 127, no. 2, 2021, pp. 196-204.
Dobbs TD, Gibson JAG, Fowler AJ, et al. Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study. Br J Anaesth. 2021;127(2):196-204.
Dobbs, T. D., Gibson, J. A. G., Fowler, A. J., Abbott, T. E., Shahid, T., Torabi, F., Griffiths, R., Lyons, R. A., Pearse, R. M., & Whitaker, I. S. (2021). Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study. British Journal of Anaesthesia, 127(2), 196-204. https://doi.org/10.1016/j.bja.2021.05.001
Dobbs TD, et al. Surgical Activity in England and Wales During the COVID-19 Pandemic: a Nationwide Observational Cohort Study. Br J Anaesth. 2021;127(2):196-204. PubMed PMID: 34148732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study. AU - Dobbs,Thomas D, AU - Gibson,John A G, AU - Fowler,Alex J, AU - Abbott,Tom E, AU - Shahid,Tasnin, AU - Torabi,Fatemeh, AU - Griffiths,Rowena, AU - Lyons,Ronan A, AU - Pearse,Rupert M, AU - Whitaker,Iain S, Y1 - 2021/06/18/ PY - 2021/03/16/received PY - 2021/04/29/revised PY - 2021/05/04/accepted PY - 2021/6/22/pubmed PY - 2021/7/28/medline PY - 2021/6/21/entrez KW - COVID-19 KW - anaesthesia KW - public policy KW - surgery KW - surgical activity KW - waiting list SP - 196 EP - 204 JF - British journal of anaesthesia JO - Br J Anaesth VL - 127 IS - 2 N2 - BACKGROUND: A significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. METHODS: We used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021. RESULTS: The total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740-5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066-2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587-3 100 808) up to December 31, 2021. CONCLUSIONS: The volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/34148732/Surgical_activity_in_England_and_Wales_during_the_COVID_19_pandemic:_a_nationwide_observational_cohort_study_ DB - PRIME DP - Unbound Medicine ER -