COVID-19 pandemic to affect nearly 400,000 elective surgeries across Canada by mid-June: study

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A newly released study projects that nearly 400,000 elective surgeries across Canada will have been cancelled or delayed across the country by mid-June due to the COVID-19 pandemic, creating a backlog that could take more than a year to clear.

As many as 28 million elective surgeries could see the same fate around the world during the pandemic, according to the study’s peer-reviewed findings, published this week in the British Journal of Surgery.

The researchers say surgery cancellations at this scale will have a “substantial impact” on patients, as well as cumulative and “potentially devastating consequences” for health systems around the world.

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

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“When hospitals resume elective activities, patients are likely to be prioritised by clinical urgency, resulting in lengthening delays for patients with benign but potentially disabling conditions where there may be less of a perceived time impact.”

The study by COVIDSurg Collaborative and led by researchers at the University of Birmingham was based on a 12-week period of peak disruption to hospital services around the world.

Each week of disruption would mean another 2.4 million cancelled surgeries globally, including 32,881 in Canada, the study estimates. In all, 72.3 per cent of planned surgeries around the world would be cancelled through the peak disruption period.

“We knew at the time that we were starting this study that Wuhan in China had already had a 12-week peak period for which they had cancelled their elective surgeries,” said Janet Martin, an associate professor at Western University’s Schulich School of Medicine and Dentistry, and member of the study.

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“We anticipated then that that might be the best estimate of how long a peak shutdown period might occur in other countries of the world if we were each to experience such an epidemic peak.”

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Canada has already seen elective surgeries cancelled or delayed for the past eight weeks, Martin said, placing our 12th week somewhere in mid-June.

“We’re just now starting to talk about how do we restart our elective surgeries, so that 12 weeks is likely to be quite accurate for the Canadian setting,” she added.

An exact number of surgeries cancelled will likely be known later this year.

Figures from Ontario Health show the number of surgeries performed in operation rooms in the province has plummeted because of the pandemic — down as much as 93 per cent for non-oncology surgeries.

According to the province, 90,297 non-oncology surgeries were performed last year between March 17 and May 12, compared to 6,168 surgeries for the same time period this year.

For oncology surgeries, 7,987 were performed in the same time period in 2019, compared to 5,317 in 2020 — a decrease of 33 per cent.

According to the Financial Accountability Office, an additional 12,200 elective surgeries are delayed every week the pandemic goes on.

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Last month, Toronto’s University Health Network estimated that at least 35 people in Ontario may have died during the pandemic because their cardiac surgeries were delayed.

Some scheduled surgeries are expected to restart as part of Ontario’s reopening plans, stage one of which was detailed on Thursday, while in B.C., the province says it will begin rescheduling elective surgeries starting May 18.

In Alberta, more than 1,000 non-urgent surgeries have already taken place.

For the study, the team compiled elective surgery cancellation plans from surgeons at 359 hospitals in 71 countries around the world.

The surgeons were asked to report actual cancellation rates, likely cancellation rates or cancellation estimates, depending if their hospitals had experienced an outbreak or not, and whether the outbreak was active or had resolved.

“Some of [the surgeons] already were in the midst or on the back of the tail of their epidemics, so they already knew what the cancellation rates actually were,” Martin said.
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That data was later modeled to estimate totals for 190 of the United Nation’s 193 member states, the study says. Liechtenstein, North Korea and Somolia were excluded as no surgical volume data was available.

“I think it’s going to be really interesting then for us now, once we’re on the backside of the curve, to figure out how close were we to the reality of what did happen,” she said.

A chart from the COVIDSurg Collaborative study showing the projected global impacts the pandemic will have on particular elective surgery procedures. COVIDSurg Collaborative

Most of the cancelled surgeries, the study says, would be for non-cancer conditions, with orthopaedic procedures seeing the highest number of cancellations over the 12-week period — around 6.3 million, a cancellation rate of 82 per cent.

However, around 2.3 million cancer surgeries, including more than 27,000 in Canada, are also projected to be cancelled or postponed.

The disruption from COVID-19 raises fears of a large post-pandemic surgery backlog that could take over a year to clear.

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The study estimates it would take countries a median of upwards of 90 weeks to clear their 12 week backlogs if post-pandemic surgical volumes increased 10 per cent from pre-pandemic levels. The median lowers to 30 weeks if surgical volumes increase 30 per cent.

“That’s something that we also really have to deal with and find fair ways to prioritise which surgeries happen first, and how to manage that with our resources and our people and our available operating equipment and rooms,” Martin said.

The researchers say governments should develop recover plans and implement strategies to safety restore surgical activity to “mitigate against this major burden on patients.”

The full COVIDSurg Collaborative study can be read here.

— With files from The Canadian Press

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