For months, the coronavirus pandemic forced hospitals to delay elective surgeries as doctors turned their attention to treating COVID-19 patients, but the spigots on non-urgent procedures are about to reopen.
Unfortunately, two new reports from Johns Hopkins University researchers suggest that hospitals will be stretched to the limit by the oncoming surge of rescheduled surgeries.
“Even if patient demand was diminished by 50%, which is a tremendous number, then there’s still going to be a backlog of almost 400,000 cases in orthopedics” alone, said Dr. Amit Jain, a spinal surgeon at Hopkins and co-author of one of the reports.
“Without expanding surgical capacity and enabling providers to see patients in an efficient manner, this phenomenon of waiting lists could be very, very real,” Jain added.
Hopkins researcher and associate professor Tinglong Dai, who coauthored a report that predicted a backlog of skin cancer surgeries, likened the surge to “the network effect.” For example, Dai has delayed taking his kids to the pediatrician this month due to concerns about exposure to the virus, but once his friends and neighbors start sending their kids to pediatricians, he said he might do the same.
Along with the anticipated spike in demand for elective surgeries, new COVID-19 safety protocols will likely overextend hospitals, the researchers said. Waiting rooms will have to be kept at a lower capacity to ensure social distancing. Health care providers and patients will need massive amounts of clinical masks and other protective equipment, which are still in short supply in some U.S. states. Patients will need to be tested for the coronavirus before being considered for surgery.
At the same time, the conditions of many patients will become more urgent as their elective surgeries are delayed, the researchers said.
Jain’s study, published recently in the Journal of Bone and Joint Surgery, found that it may take between seven and 16 months for orthopedic surgeons to get back to performing 90% of the surgeries completed at pre-pandemic efficiency. Even in the optimistic seven-month scenario, the study found there will be close to 1 million orthopedic surgeries delayed.
The researchers explained there will be a “fixed” backlog, comprising all the patients whose surgeries were put on hold from mid-March through mid-May. Then another backlog will grow as orthopedic surgeons continue to work at a lower efficiency because of having to follow time-consuming COVID-19 safety protocols.
Unlike knee and hip replacements, which are generally non-urgent, spinal surgeries are more akin to cancer surgeries and they often become increasingly urgent as they are delayed, Jain said. Many of his patients have spinal stenosis, a painful abnormality of the spine. Back in March, most of these patients were considered “not urgent,” but the condition of some has now worsened. “They are going to start transitioning into that urgent category,” Jain said.
Meanwhile, a second Hopkins report predicts a surge in skin cancer surgeries that could stretch in a six-month backlog. Those researchers came to that conclusion after turning to evidence of surgery delays following the Ebola outbreak in West Africa.
Both reports highlight the urgency of helping hospitals plan for the onslaught.
The researchers recommend surgical departments prioritize waiting lists according to several considerations, including the urgency of a case, as well as factors such as age and underlying health conditions, which contribute to a patient’s risk of mortality if infected with COVID-19.
They also suggest that surgeons adjust their schedules based on each patient’s considerations. To do so, patients need to get in line for surgeries as soon as possible.
“It’s very important for patients to understand that now surgeons won’t have a lot of capacity,” explained skin cancer report researcher Ge Bai, an associate professor of health policy and management. “They need to get checked by primary care physicians so that they can be referred to a surgeon and have the best chance of being treated in a timely manner.”
Some experts see this moment as an opportunity to reimagine health care. For example, Jain said, the overextension of surgical departments could push the system towards eliminating unnecessary surgeries, an expense that contributes greatly to the country’s overall health care spending.
Visit the U.S. National Library of Medicine for more on surgery.