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Consequences of Delaying Elective Surgeries

Both patients and the healthcare system show substantial impact

BY MAIA KUNKEL | JUNE 2020

As the COVID-19 lockdown eases across the US, 39 states have now issued orders or guidance allowing for the resumption of elective procedures; Hawaii remains the last state to have an ongoing executive order halting elective procedures, which expires at the end of June. Governors in 35 states and Washington, DC, halted elective surgeries back in March to preserve personal protective equipment (PPE) and prevent the spread of infection.

Delaying “time-sensitive” elective procedures caused deteriorations in health, worsened quality of life, increased disability and decreased work capability for patients, according to a study published in the British Journal of Surgery. The study collected country-level surgical data and modeled cancellation rates to determine that during the peak 12 weeks of interruption in elective procedures, more than 28 million surgeries were postponed or canceled globally due to the COVID-19 pandemic. This totaled to more than 2 million surgeries globally per week, and more than 300,000 procedures in the US per week. While noting that delaying elective surgeries decreases the chance of viral transmission and associated postoperative pulmonary complications, the study revealed that delaying elective procedures would have a substantial impact on both patients’ health and healthcare systems around the world. Excessive delays in elective procedures could also cause unnecessary deaths, the study concluded.

Even after elective surgeries resume, drastic delays caused by backlogs of patients waiting for their procedures would remain for months, according to the study. If countries could increase surgical volume by 20 percent after elective surgeries began to resume, it would take on average 45 weeks to clear the backlog caused by the pandemic. When healthcare systems begin resuming elective procedures, patients might need to be prioritized by clinical urgency, possibly resulting in even greater delays for patients deemed to have a less medically urgent condition, the study stated.

Other consequences of delaying elective procedures include negative effects on patients’ mental health. Physicians found a drastic increase in patients’ anxiety over delays in their elective procedures, according to an article in the Washington Examiner. Anxiety caused by delayed procedures led patients to believe they had more symptoms, making it harder for physicians to tell which symptom was real and which was not, the article stated. Physicians also noted an increase in opioid use in patients who have had their elective procedures delayed, which could potentially result in greater pain and a longer recovery time after surgery. A potential increase in emergency cases and unnecessary complications were the other consequences of delaying elective procedures, according to the article.

In an interview with NPR, Daniel Buckland, MD, attending physician at Duke University Hospital in Durham, North Carolina, discussed the difficult balance of preserving PPE and monitoring patients to ensure their conditions do not worsen from delayed surgery. For example, delaying gallbladder procedures could lead to increased pain, blockages and inflammation, which could quickly spiral into an emergency procedure, Buckland said.

Healthcare delivery changed over the last few months, according to an article in The New England Journal of Medicine. For those patients for whom surgery was not delayed, many feared contracting COVID-19 and were reluctant to go through surgery. The distinction between urgent and nonurgent can often be truly determined in retrospect only, according to the article. Canceling seemingly straightforward elective procedures—such as hernia repair and knee replacements—could become complex. Although these procedures are deemed elective, many of these surgeries could be urgent and patients could not always wait several months to receive care without harm. Instead of a broad moratorium on all elective procedures, a case-by-case approach for each patient needing an elective procedure would be more effective for determining urgency and prioritization of care, the article stated.