Berlin - Millions of surgical interventions around the world are currently being postponed due to the COVID-19 pandemic, including numerous cancer operations - and it will take many months, if not years, until the resulting bow wave is processed again. This is the conclusion of global data survey now published in the published by scientists from department of the National Institute for Health Research () at the University of Birmingham in England.
A period of 12 weeks was taken as the basis, depending on the country and course The corona crisis was different, but everywhere included the respective climax of the interruptions to normal clinical processes.
From this The modeled estimate showed that every additional week in which the corona crisis forces the operational departments to redirect capacities is associated with around 2.4 million more postponements of surgical interventions worldwide. Taken together, this results in total of 28 million operations postponed for 12-week period.
The data come from detailed information from 359 clinics in 71 countries - which are then extrapolated for 190 countries and in detailed one Excel table for each country can be found in the appendix of the publication. A comparable data set has not yet been collected or published.
It is the first original work by the CovidSurg Collaborative Group, an international association of more than 5,000 surgeons from more than 120 countries, which is struggling with the current challenges The SARS-CoV-2 pandemic has come together to collect and evaluate data at short notice so that it can serve as an orientation aid for improved patient care in the future.
"The data from survey of 34 German Hospitals ”explains Markus Albertsmeier, surgeon at the Munich LMU clinic who works with other German surgeons at CovidSurg. For Germany, for example, this results in number of 908,759 postponed operations, including around 850,000 elective (or benign) interventions.
That is 85% of all elective operations postponed. In addition, 52,000 cancer operations have been postponed, which is 24% of all interventions for malignant diseases. These German numbers projected for 3 months are not nearly as high as the number of operations postponed between mid-March and early May recently estimated by the Rheinische Fachhochschule Köln (2), but they are still substantial. The data currently collected globally are considered valid, which also proves their comparability with other countries.
They look similar for example for France or the United States. In the neighboring country there are 700.000 and in the US 3.8 million postponed operations. In both countries, almost 1/3 of those operations involving malignant diseases were postponed.
Not every postponement of oncologically indicated interventions must be associated with worsening of the prognosis. In addition, radiation therapy, for example, offers an alternative treatment option for some tumors. "The German capacities are generally assessed in such way that no urgent cancer operation has to be delayed," emphasizes Albertsmeier.
The poorer the country, the more cancer operations are postponed
However, it is noticeable that it is there is global gap that correlates with the wealth of country. The original data of the publication show very clearly: the poorer the country, the more frequent it is no longer just the elective operations such as total joint endoprostheses that can no longer be performed promptly.
So in Norway are similar to in this country only 23% of cancer operations postponed, in Brazil already 44%, in Vietnam 56% and in Sudan - like the average of many poor countries - 72%. Even in countries that are among the “upper middle income” nations, 43.4% of all postponed surgical interventions already concern malignant diseases.
This means that in socio-economically second place out of total of 4 In categories (high, upper-middle, lower-middle, and low-income), almost half of cancer surgeries fell victim to postponement. Most often, gynecological tumor resections, those of the upper gastrointestinal tract, liver and biliary tract, are postponed, followed by malignancies of the head and neck, urological tumors and colon cancer. In the case of elective interventions, the orthopedic surgeons were most likely to have to put their patients off; 6.3 operations worldwide were delayed for the time being in this field.
The study authors assume that beds for COVID-19 patients will be created in the course of the corona crisis have been released. "Since hospitals in the socio-economically worst-off countries most likely have limited intensive care beds, they will probably have to cancel large part of the cancer operations, while the hospitals in the richer countries can better balance this," is the hypothesis of study author Dmitri Nepogodiev of the NIHR Department for Global Surgery at the University of Birmingham.
"That means, fragile health systems suffer from most ”, the researcher emphasizes to the Deutsches Ärzteblatt. In his opinion, resources should be mobilized as soon as possible so that the backlog of operations can be dealt with as quickly as possible.
However, this is not that easy and cannot be implemented very quickly. In addition, considerable additional financial funding must be made available to ramp up capacities.
The magnitudes to be expected here are calculated by the authors of the current study using the example of Great Britain. After that, the necessary investments would cost the National Health Service () around 2 billion British pounds.
In order to gain additional operating room capacity at all, operating theaters might have to be converted, for example with negative pressure flow systems , with the help of which the infectious aerosol formation can be reduced.
"If you stick to the data of the now published scientific work, it could take between 30 and 89 weeks, if the aforementioned numbers are correct this backlog would have been made up - depending on whether the throughput of operations would be increased by 10 or 30%, "says Andreas Schnitzbauer.
But in principle, the safety of the surgical patients must also have top priority. Because, for example, in view of new data collection by the CovidSurg Collaborative Group, it is becoming apparent that patients could have increased perioperative risks even during elective interventions if they become infected with SARS-CoV-2 immediately before or after the operation.
"We therefore believe that the current changes caused by the coronavirus pandemic are also leading to new challenges for surgical care in Germany, which will not only exist in the short term," summarizes the deputy director of visceral surgery at the Frankfurt University Hospital.