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Resource requirements for reintroducing elective surgery in England during the COVID-19 pandemic: a modelling study

By A J Fowler, T. D. Dobbs, Yize I Wan, R. Laloo, S. Hui, D. Nepogodiev, A. Bhangu, I S Whitaker, R M Pearse, T E Abbott

Posted 12 Jun 2020
medRxiv DOI: 10.1101/2020.06.10.20127266

BackgroundThe COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures in the National Health Service (NHS) England due to COVID-19, and the reintroduction of surgical activity, was modelled. MethodsModelling study using Hospital Episode Statistics data (2014-2019). Using NHS England definitions, surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1st March 2020 and 28th February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1st June 2020. Costs were calculated using NHS reference costs and are reported as millions(M) or billions(B) of Euros({euro}). Estimates are reported with 95% confidence intervals. Results4 547 534 (3 318 195 - 6 250 771) patients with pooled mean age of 53.5 years were expected to undergo surgery between 1st March 2020 and 28th February 2021. By 31st May 2020, 749 247 (513 564 - 1 077 448) surgical procedures were cancelled. Assuming elective surgery is gradually reintroduced, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28th February 2021. The cost of delayed procedures is {euro}5.3B ({euro}3.1B - {euro}8.0B). Safe delivery of surgery during the pandemic will require substantial extra resources costing {euro}526.8M ({euro}449.6M - {euro}633.9M). ConclusionReintroduction of elective surgery in NHS England will be associated with substantial treatment delays, and large cost increases. The challenges and costs of reintroducing surgical care in other healthcare settings may differ and further research to monitor the recovery of surgical care is urgently required.

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