Tens of millions of surgeries are being postponed as a result of the pandemic

IT IS NOW well established that face masks are an effective tool for slowing the spread of the coronavirus. But in Japan such face-coverings are being used for another, less urgent, purpose: concealing post-surgery swelling. Last week Kyodo News, a wire service, reported a surge in demand for cosmetic surgery in the country. The phenomenon appears to be driven more by convenience than necessity. “Some patients who could not go to work and had extra free time thought of having cosmetic surgery,” says Yoshimura Kotaro, a director at the Japanese Society of Plastic and Reconstructive Surgery (JSPRS).

This is the exception, not the rule. During the pandemic hospitals around the world have cut back on routine surgeries and procedures to maintain patient safety, and to free up capacity for the deluge of coronavirus patients. England’s National Health Service (NHS) reckons that it has already postponed more than 2m planned operations, freeing up 12,000 beds for covid-19 patients. Some recovery areas have been repurposed as overflow intensive care units. Surgeons and nurses have been redeployed. Hospitals have had to ration personal protective equipment (PPE) in places where it is in short supply.

How many operations have been delayed or cancelled? Many governments do not publish timely data. To estimate the impact, researchers at the University of Birmingham asked doctors around the world directly, surveying more than 500 specialists from 359 hospitals in 71 countries. They plugged the data into a statistical model to estimate cancellation rates across 190 countries. They assumed that, based on the experience of China, health-care systems are typically disrupted by the coronavirus for 12 weeks. The study found that, in that space of time, globally, more than 28m elective surgeries have been or will be cancelled or postponed. Of these, the vast majority, 26m, will be for benign conditions. But 2.3m cancer surgeries will also be delayed, as will nearly half a million elective Caesarean sections. Health systems in poor countries, eg, in sub-Saharan Africa, are less resilient and so more prone to disruption. Moreover, even small changes amount to large percentage variations in countries that perform relatively few surgeries.

Amid the pandemic, hospitals have had to weigh the cost of delaying such procedures against the risk of exposing more people to the virus. Inevitably some people will be harmed by unexpected treatment delays. “Patients waiting for joint replacements may go from the occasional sleepless night to every night becoming sleepless because of pain,” says Derek Alderson, the president of the Royal College of Surgeons of England. Some patients may become addicted to opioids used to manage pain. Other consequences may include job losses and mental strain.

Private hospitals are already feeling the financial pinch. According to the American Hospital Association, a trade body, providers are losing an estimated $50bn a month because of the pandemic, which has diverted resources away from lucrative elective surgeries. Clearing the backlog of surgeries will be difficult, too. The authors of the study estimate that this could take 45 weeks, assuming that hospitals can increase their surgical volume by a fifth. Doctors will also have to decide which patients should have priority when surgeries resume. Although some cases, such as tonsillectomy or weight-loss surgeries, can be delayed with little harm, others will have to be considered on a case-by-case basis.

On top of this backlog, there will be a “hidden” waiting list of patients in need of care. “Many patients have not even bothered to consult a doctor, nor have they been referred to hospital, because of their fear of contracting the coronavirus,” says Professor Alderson. As cancer patients wait, tumours continue to grow. Cancer Research UK, a charity, estimates that 2,000 cancers are falling under the radar each week and could become later inoperable. It is only a matter of time until many non-urgent surgeries become urgent.