Jordan Ellis
Elective surgery cancellations are a worldwide challenge, causing emotional and economic distress for patients and their families, as well as decreased efficiency in operating theatres. In Australia, elective surgeries were cancelled in both public and private hospitals during the COVID-19 pandemic to prepare for coronavirus patients and free up medical resources. Similarly, in New Zealand, elective surgeries have been cancelled due to record waitlist delays, with Health Minister Shane Reti requesting a briefing on the issue. Financial constraints, patient unfitness, and surgeon unavailability are significant factors contributing to elective surgery cancellations. Outsourcing elective surgeries to private hospitals is an option to tackle backlogs, but it is an expensive solution.
| Characteristics | Values |
|---|---|
| Location | Australia, New Zealand, Uganda, Brazil, the US |
| Date | 2020, 2021, 2022, 2024 |
| Type of surgery | Non-urgent, elective |
| Hospitals | Public and private |
| Reason for cancellation | Bed shortages, staff shortages, inadequate funding, focus on treating COVID-19 patients, freeing up medical staff and supplies |
| Impact | Emotional and economic trauma for patients and their families, decreased efficiency of the operating theatre, increased theatre costs, duplication of workload, waste of operating room time and resources |
| Solutions | Outsourcing to private hospitals, addressing workforce vacancies, working with GPs and primary care to reduce the number of people needing hospital care |
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What You'll Learn
Emotional and economical trauma for patients and their families
The cancellation of elective surgeries has been a worldwide challenge, with emotional and economic trauma for patients and their families. Emotional trauma can present as a lack of confidence, anxiety, and depression. For instance, a study of 157 patients in a urological department in Tanzania found that all groups with higher Hospital Anxiety and Depression Scale (HADS) scores demonstrated significantly lower satisfaction scores. Similarly, a study of pediatric outpatient surgery cancellations in a large university hospital found that 45% of parents and 16% of children were disappointed by the cancellation, 16% of parents were frustrated, and 3.3% were angry. In addition, 38.5% of mothers and 50.0% of fathers missed a day of work, and of these, 53.3% and 42.1%, respectively, went unpaid for the missed workday.
The cancellation of elective surgeries also has economic implications for patients and their families. In addition to the financial loss from missing work, patients and their families may also incur costs from additional testing and new appointments, as well as the cost of travel to and from the hospital. For example, in the study of pediatric outpatient surgery cancellations, the mean number of miles driven (round trip) to the hospital for a cancelled operation was 158.8 miles.
Furthermore, the cancellation of elective surgeries can cause stress and inconvenience, leading to a disruption in patients' daily lives and a loss of working days. This is especially true for cancellations that occur on the day of surgery or after patients have already arrived at the hospital.
The cancellation of elective surgeries also has implications for the efficiency of operating theatres and hospitals. It increases costs, decreases efficiency, duplicates workload, and wastes operating room time and resources. For example, a study of theatre cancellations at Beaumont Hospital between April 1997 and March 2002 found that the number of elective operations cancelled increased from 368 between April 1997-March 1998 to 427 between April 2001-March 2002. In addition, the reason for theatre cancellation due to 'no bed' increased from 114 (31.0%) cases between April 1997-March 1998 to 267 (62.5%) cases between April 2001-March 2002.
While the cancellation of elective surgeries can have negative consequences, it is important to consider the reasons behind such cancellations. In some cases, cancellations may be necessary to prioritize acute cases, address staffing or resource shortages, or due to unforeseen circumstances such as the COVID-19 pandemic. For example, in March 2020, the Australian federal government and NSW Health cancelled all non-urgent elective surgeries across public and private hospitals in St. George and Sutherland Shire to focus resources on battling the coronavirus outbreak.
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Staff shortages and illness
During the COVID-19 pandemic, hospitals faced the challenge of managing an exponential increase in emergency department (ED) visits and inpatient admissions. This, coupled with the risk of healthcare workforce shortages due to viral exposure, illness, and school closures, led to concerns about the capacity to handle a potential surge in coronavirus cases. As a result, the United States Surgeon General recommended cancelling elective surgeries to prevent the spread of the virus within healthcare facilities and to conserve critical medical resources.
In response to the Surgeon General's advisory, hospitals across the United States debated the safety and feasibility of continuing elective surgical procedures. While some hospitals pushed back against the recommendation, others heeded the call and began postponing or cancelling elective surgeries to make room for coronavirus patients. This decision was not without controversy, as many healthcare professionals misinterpreted the advisory as a blanket directive to cancel all elective procedures, potentially causing harm to patients whose surgeries were delayed or cancelled.
Staff shortages in hospitals have been a significant issue during the COVID-19 pandemic, leading to the cancellation or postponement of elective surgeries. For example, in Massachusetts, the Massachusetts Health & Hospital Association (MHA) announced updated guidance in November 2021 to reduce certain non-essential elective procedures due to staffing shortages. Similarly, in Vancouver, cardiac surgeries have been cancelled due to staff shortages, with more than 100 procedures affected at St. Paul's Hospital alone in the first six months of 2024.
The issue of staff shortages is not unique to the United States and Canada. In Victoria, Australia, the state's peak public hospital body warned that elective surgeries might need to be scaled back due to anticipated staff shortages as the Omicron subvariant wave peaked. This warning came as four health services across the state were already struggling to meet the minimum nurse-to-patient ratios. The main problem, according to the VHA's chief executive, Tom Symondson, was a historic shortage of healthcare workers in Victoria, exacerbated by border closures and burnout.
To summarize, staff shortages and illness during the COVID-19 pandemic have significantly impacted the delivery of elective surgeries. Hospitals have had to make difficult decisions to postpone or cancel elective procedures to ensure they can meet the critical care needs of an increasing number of patients, including those affected by the coronavirus. While these decisions aim to prioritize patient safety and the efficient utilization of scarce resources, they also highlight the ongoing challenges faced by healthcare systems worldwide during the pandemic.
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Bed shortages
In New Zealand, hospitals have faced challenges due to a lack of beds, staff sickness, and high acute demand. For instance, during May, 50 patients across Dunedin and Invercargill hospitals had their elective surgeries cancelled due to these factors. Similarly, in the United Kingdom, a cancer patient's surgery was cancelled three times due to a shortage of ICU beds. The patient, Gillian, expressed her distress about the situation, highlighting the urgency of her procedure.
The United States is also grappling with a hospital bed shortage that is pushing the system towards a "critical threshold." According to research published in the Journal of the American Medical Association, the national hospital occupancy rate has increased since the start of the coronavirus pandemic. Dr. Arjun Venkatesh, chair of the Department of Emergency Medicine at the Yale School of Medicine, warned that when occupancy exceeds 85%, the system slows down, making it more challenging to ensure timely surgeries and access to resources like MRIs.
The bed shortage crisis has multiple contributing factors. One significant factor is the reduction in healthcare spending, which has put federal and state governments at risk of bankruptcy. Additionally, cuts to Medicaid and Medicare reimbursements could further exacerbate the problem, as many hospitals are already financially strained. Staff shortages, including a lack of anaesthetic technicians, have also been identified as a key factor in the cancellation of elective surgeries.
To address the bed shortage crisis and reduce the cancellation of elective surgeries, policymakers and healthcare administrators must develop strategies that increase hospital capacity, improve staff retention, and ensure adequate funding for healthcare services. Without proactive measures, the situation is expected to worsen, negatively impacting patient care and outcomes.
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Financial constraints
Cancelling elective surgery can have a significant financial impact on hospitals. When elective surgeries are cancelled, especially at the last minute, it can lead to unnecessary costs, ineffective use of hospital resources, and increased expenditures. Hospitals may have to deal with the cost of wasted medical supplies and reduced operating room productivity.
During the COVID-19 pandemic, the cancellation of elective procedures had a severe financial impact on U.S. health systems, causing losses of $60 billion per month. This decision was made to prevent hospitals from being overwhelmed and to avoid situations where physicians would have to choose which patients receive a bed. While it was effective in preventing such scenarios, it had a significant financial toll and reduced access to care for patients with life-threatening and chronic illnesses.
To address financial constraints, patients can explore various options. They can compare prices between hospitals and choose facilities within their insurance plan's network. Hospitals may offer financial assistance programs, extended lines of credit, or payment plans to make medical expenses more manageable. Patients can also negotiate medical bills, especially if they express a willingness to pay but explain their financial hardship. Additionally, some hospitals provide charity care or reduced-price services for low-income or underinsured patients.
In summary, cancelling elective surgery due to financial constraints can have financial implications for hospitals and patients. Hospitals face unnecessary costs and reduced productivity, while patients may experience financial difficulties in accessing care. However, there are measures in place, such as financial assistance and payment plans, to help alleviate these constraints and improve access to healthcare.
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Lack of theatre space
Theatre space is a critical factor in elective surgery cancellations. The unavailability of operating rooms or theatre facilities is a significant cause of cancellations, particularly in cases where emergency procedures interfere with the elective schedule. This issue is prevalent in hospitals facing resource constraints, staff shortages, and inadequate infrastructure.
A study from a University Teaching Hospital in Tanzania found that lack of theatre space and facilities were the main reasons for 53% and 28.4% of elective surgery cancellations, respectively. Similarly, a study from Sarajevo identified a lack of time to perform surgery as the most common reason for cancellations, often due to overbooked surgical schedules and emergency procedures.
To address this, hospitals can improve theatre management through careful planning, efficient utilization of resources, and enhanced coordination among disciplines. A good administrator can play a pivotal role in optimizing scheduling, reducing preparation and cleaning times, and better managing resources. Additionally, hospitals can explore the implementation of waitlists or "fillbuster" lists for elective surgeries, ensuring that any available theatre time is fully utilized.
The COVID-19 pandemic has further exacerbated the challenges associated with theatre space. During the peak of the pandemic, hospitals worldwide reduced elective surgeries to prioritize patient safety, conserve resources, and support the response to the public health crisis. This led to substantial disruptions and cancellations of elective procedures, with an estimated 28,404,603 operations cancelled or postponed during the initial 12 weeks of the pandemic. As healthcare systems plan for post-pandemic recovery, they must anticipate potential future waves of infections and develop strategies to maintain surgical volumes, including exploring designated non-COVID-19 units for time-sensitive procedures.
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Frequently asked questions
Elective surgeries are non-urgent procedures that can be scheduled in advance as they do not need to be performed immediately.
Elective surgeries are often cancelled due to resourcing issues, such as staff illness or unavailability, or increased bed usage. The COVID-19 pandemic also caused elective surgeries to be cancelled worldwide to free up medical staff and supplies for coronavirus patients.
Yes, elective surgery cancellations can occur in both public and private hospitals. Private hospitals may also face cancellations due to financial constraints.
If your elective surgery is cancelled, you should contact your doctor or hospital to understand the reason for the cancellation and to discuss alternative arrangements.
