At least 200,000 people missed essential surgery due to Covid, conference told

At least 200,000 people missed out on essential surgery as a result of the Covid-19 pandemic, with many enduring “misery and daily pain” as a result, a conference has heard.

Both scheduled and emergency surgery levels dropped by 20 per cent during the pandemic, suggesting there is now significant pent-up demand for treatment, according to the national clinical lead in surgery, Prof Deborah McNamara.

Almost 343,000 people are waiting to see a surgeon for the first time, 100,000 of whom have been on a waiting list for more than 18 months, she told the conference on outcomes from the pandemic at the Royal College of Surgeons in Ireland (RCSI).

This was only the start of delays for patients, she pointed out, as they have to wait again for their procedure to be carried out. Currently, more than 71,000 patients are waiting for surgery, a fifth of whom have been on the list for more than a year.

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Pointing to the 18,000 people waiting more than 18 months for knee, hip and other orthopaedic operations alone, Prof McNamara said many of these patients endure daily pain, are starting to become disabled or are having their work affected.

Long-waiting patients needing complex surgery have been disproportionately affected, she said, as the system focused on treating “quick-win” procedures such as endoscopies. The amount of day-case work carried out by hospitals is back to 84 per cent of 2017 levels, yet complex care remains at only 67 per cent, she pointed out. Patients waiting for surgery were enduring a “huge amount of misery” that remains unquantified, according to Prof McNamara.

Positive changes

The pandemic resulted in some positive changes, she said, including shorter hospital stays, a greater role for physician associates and a generational change in the use of IT. However, it also led to greater constriction in the capacity for scheduled surgery, and greater seasonal variations in demand.

Prof McNamara criticised the “retrograde” outsourcing of surgery to the private sector as the preferred model for cutting waiting lists. “It’s all about the operation and very little else matters. There is no point replacing a person’s hip if they don’t get really good physiotherapy after the operation.”

This was leading to the “disintegration” and fragmentation of care, she warned, by disconnecting the surgical procedure from wider treatment and rehabilitation by teams of doctors. Complex care is largely excluded from outsourcing initiatives and no data is available to evaluate outcomes.

Criticising excessive duplication of services in health, Prof McNamara called for fewer hospitals delivering 24/7 emergency care and more elective capacity. It made “no sense” to have surgeons with 20 years’ experience doing minor surgery when this can be done by advanced nurse practitioners.

Surgeons need to be seen not as "the epicentre of the universe" but as members of a team providing care, she said. Prompt access to emergency surgery is a norm of civilised society, and the fact that Ireland was failing to deliver this to international norms is "problematic" for our society.