Projecting COVID-19 disruption to elective surgery.

Millions of elective surgical procedures were cancelled worldwide during the first wave of the COVID-19 pandemic. This enabled redistribution of staff and resources to provide care for patients with COVID-19 and addressed evidence that perioperative SARS-CoV-2 infection increases postoperative mortality. Although some hospitals established COVID-19-free surgical pathways to create safe elective surgery capacity, the National Health Service (NHS) in England has not returned to pre-pandemic elective surgery activity levels.

The NHS faces winter pressures every year but enters this winter in a particularly fragile state. The emergence of the omicron SARS-CoV-2 variant raises the possibility of rapid increases in COVID-19 admissions and intensified pressure on elective care. We used NHS England activity data from the period following the end of the first COVID-19 wave (ie, from September, 2020, onwards) to estimate how increases in the number of hospital beds occupied by COVID-19 inpatients at any one time might affect elective surgery activity in England over the coming winter months. We calculated the potential shortfall in projected elective surgery activity from December, 2021, to February, 2022, compared to the same period in 2019 before the COVID-19 pandemic. Full methodology is described in the appendix.

If the number of COVID-19 inpatients in England were to remain at the level seen in the first 2 weeks of October, 2021, when, on average, 5003 patients were receiving treatment for COVID-19, we project that 51 204 (95% CI 44 219–58 343) elective surgical procedures would take place per week (figure ). If the average number of COVID-19 inpatients were to increase to 10 000, 47 348 (39 206–56 641) elective surgical procedures would take place per week. If the number of COVID-19 inpatients were to increase to the levels seen in the first COVID-19 wave (in April, 2020, there was an average of 16 090 COVID-19 inpatients in England at any one time), elective surgical procedures would decrease to 43 225 (33 859–54 633) per week.

Figure

Projected number of weekly elective surgical procedures in England from December, 2021, to February, 2022, based on number of hospital beds occupied by COVID-19 inpatients in England at any one time

Shaded area indicates 95% CI.

These data suggest that if the number of COVID-19 inpatients were to reach levels seen in April, 2020, rather than continue at levels seen in October, 2021, 100 273 fewer elective surgical procedures would take place over the next 3 months—a 15·3% reduction.

There are limitations to our analysis. First, we assume that the relationship between the number of COVID-19 inpatients and elective surgery activity this winter will be consistent with previous trends. However, the NHS might develop strategies to maintain elective surgery activity despite increasing COVID-19 admissions; conversely, resilience could by diminished by escalating staff shortages. Second, we did not explore regional variation, which could arise as a result of differences in resource availability, accessibility of COVID-19-free surgical pathways, or baseline surgical case mix. Finally, we have not addressed differences between surgical specialties. Hospitals are likely to prioritise life-saving surgeries, meaning that less time-critical surgeries are more vulnerable to COVID-19-related disruption.

Nevertheless, further disruption to elective surgery seems inevitable unless robust measures are urgently introduced to prevent escalating COVID-19 hospitalisation rates in England. Delayed implementation of COVID-19 mitigation measures risks lockdown, which itself could amplify disruption to urgent surgery.

Members of the COVIDSurg Collaborative are listed in the appendix. The authors declare no competing interests. The work presented in this Correspondence was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funders had no role in study design, data collection, analysis and interpretation, or writing of this Correspondence. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care.