Prioritising patients for emergency surgery or not: the impact of COVID-19 (ESORT-C19) London School of Hygiene and Tropical Medicine

The COVID-19 pandemic had a major impact on surgical provision, as ventilators, hospital space and staff were redeployed, and guidelines increased the thresholds for emergency surgery.

This research study assessed the impact of the first wave of COVID-19 on access to emergency surgery and patient outcomes; and the impact of the second and third waves on mortality and emergency hospital admissions. It also looked at how patient and public involvement (PPI) processes were adapted during the pandemic.

The project team used Hospital Episode Statistics data on emergency admissions to NHS hospitals for five acute conditions (acute appendicitis, acute diverticular disease, acute gallstone disease, abdominal wall hernia, intestinal obstruction), comparing admissions during the three waves of the pandemic in England with the corresponding periods in 2019. 

For each of the conditions studied, the total number of emergency admissions was reduced during the first wave of COVID-19 compared to the corresponding period in 2019. During the first wave, a higher proportion of these people died than was expected. 

The research found that by the third wave of COVID-19 in England, the proportion of patients who died following these emergency admissions had returned to typical pre-COVID levels. The findings emphasise the importance of maintaining, or quickly restoring, capacity for emergency surgery to manage the subsequent influx of emergency admissions following a severe shock to the health system.

The research team held online discussions with PPI members, with training materials provided in advance to help them understand the purpose of the study. The online meetings encouraged a wide range of PPI members to attend, involved broad discussion, strong engagement and the generation of new research ideas.

The research team will carry out further studies on whether ‘early’ versus ‘later’ surgery is more effective and cost-effective for patients with common vascular conditions, and whether radiotherapy is more effective and cost-effective than surgery for people with common early-stage cancers.

Contact

For more information about this project, please contact Richard Grieve, Professor of Health Economics Methodology, London School of Hygiene and Tropical Medicine.