28 million elective surgeries may be cancelled worldwide: how non-COVID-19 medical care is suffering

COVID-19’s long-lasting impact on our health could include more than 28 million cancelled or postponed operations, creating a backlog that will take the best part of a year to clear. And the number could be even worse if lockdowns continue for longer, according to a new study.

Using data from surgeons in 359 hospitals across 71 countries, CovidSurg Collaborative researchers, including those from the University of Birmingham, created a statistical model to estimate the total number of cancelled elective surgeries during 12 weeks of peak disruption in 190 countries. Their result was 2,367,050 operations per week.

These numbers are likely to worsen for each additional week that the lockdown or restrictions continue, underscoring how COVID-19's widespread scars on health go beyond the direct impact of the virus. The United Nations has already warned that pregnancy and birth services will probably suffer, and some mass vaccination campaigns have been temporarily suspended.

“Cancelling elective surgery at this scale will have substantial impact on patients and cumulative, potentially devastating consequences for health systems worldwide,” says Aneel Bhangu, a consultant surgeon and senior lecturer at the University of Birmingham.

“Delaying time-sensitive elective operations, such as cancer or transplant surgery, may lead to deteriorating health, worsening quality of life, and unnecessary deaths.”

Most of the cancellations are operations for benign disease, the research shows. Globally, 81.7% of benign surgery, 37.7% of cancer surgery, and 25.4% of elective caesarean sections would be cancelled or postponed, the research shows.

It also predicts that it will take around 45 weeks to clear the backlog of operations, if countries increase their normal surgical volume by 20% after the pandemic.

Around the world, the cancellation or postponement of routine procedures risks widening the gap in access to health services.

Disadvantaged and marginalized people face worsening health inequalities as a result of the difficult choices made by UK NHS hospitals in response to the pandemic, separate research in the Journal of the Royal Society of Medicine showed. That’s because emergency departments, which have seen steep declines in attendances, are often used by vulnerable people, including the homeless and migrants.

These groups often lack access to the technology or broadband that would allow them to utilize online or remote consultations. Many health practitioners resorted to seeing patients virtually as social distancing measures were put in place, but that raises challenges for rural areas.

The authors of the CovidSurg Collaborative report said governments should already be thinking about recovery plans and strategies to get back to normal levels of surgical activity, highlighting the economic and societal costs of not doing so.

They said that more research is needed in this area, since their work was based on several assumptions. Even so, dangers remain.

“There is a risk that delayed treatment of benign conditions as a result of pandemic-related cancellations will lead to deterioration in individual patients’ conditions, increasing disability and reducing their ability to work,” the researchers wrote. “This will lead to substantial societal costs.”