Abstract

The coronavirus pandemic put the healthcare system under severe stress. Hospitals prioritised medical care for coronavirus patients, particularly in the early stages of the crisis. This resulted in a lack of capacity and staff for the provision of care that was not directly coronavirus-related. And often in the postponement of care, such as certain surgical procedures, for conditions that were not immediately life-threatening.

People whose surgery was postponed during the coronavirus pandemic experienced a longer period of ill health than they would otherwise have done. RIVM has estimated the effect of the postponement of surgery on the health of people who were affected by this in 2020 and 2021. At the end of 2021, roughly 305 thousand fewer operations had been performed than were anticipated for 2020 and 2021 prior to the onset of the pandemic. The total number of postponed surgical procedures was higher, but some of these procedures were already executed before the end of 2021. In total, around 320,000 healthy life years were lost in 2020 and 2021 due to postponed operations. This equals 18 percent of the positive health effect that would have resulted from the operations if they had gone ahead.

This study looks at operations that could be postponed for longer than a month. Under normal circumstances, hospitals in the Netherlands perform more than 900,000 operations of this type a year. The majority of estimated health losses occurred due to postponed operations in the areas of ophthalmology and orthopaedics, such as cataract, hip and knee operations, and in the area of surgery, such as bariatric surgery. Operations that could not be postponed for longer than a month, such as operations for cancer and surgery following traffic accidents, mostly went ahead and were therefore not included.

The loss of healthy life years is a minimum estimate. Because not all forms of care were included in the calculation, total health losses are likely to have been higher. For example, the calculation did not include health losses as a consequence of postponed diagnoses and outpatient care.

Due to the staff shortages in healthcare, it is by no means certain that hospitals will be able to catch up with the backlog of operations in the coming years. RIVM has also estimated how many permanent health losses could be avoided if the number of operations were to be increased by between 2 and 5 percent over the next 5 years. This would result in a small reduction in those health losses.

These results underline the importance of ensuring the continued provision of regular medical care as far as possible in times of crisis. For instance, such measures could include an agreement about the circumstances under which private care providers or hospitals in other countries could step in. Another option is to use the surgical capacity as much as possible for procedures that result in larger health gains.