Key result
Doubling surgical capacity leaves ~31% of patients waiting over 2 weeks for carotid endarterectomy.
Why the study?
The COVID-19 pandemic caused a large backlog of patients awaiting time-sensitive surgeries like carotid endarterectomy, creating challenges for hospitals to manage surgical capacity and ensure timely care during recovery.
Capacity doubling may not meet 2-week CEA targets post-disruption; simulation modeling leaves open optimal recovery strategies.
Background The COVID-19 pandemic presents unparalleled challenges for the delivery of safe and effective care. In response, many health systems have chosen to restrict access to surgery and reallocate resources; the impact on the provision of surgical services has been profound, with huge numbers of patient now awaiting surgery at the risk of avoidable harm. The challenge now is how do hospitals transition from the current pandemic mode of operation back to business as usual, and ensure that all patients receive equitable, timely and high-quality surgical care during all phases of the public health crisis. Aims and Methods This case study takes carotid endarterectomy as a time-sensitive surgical procedure and simulates 400 compartmental demand modelling scenarios for managing surgical capacity in the UK for two years following the pandemic. Results A total of 7,69 patients will require carotid endarterectomy. In the worst-case scenario, if no additional capacity is provided on resumption of normal service, the waiting list may never be cleared, and no patient will receive surgery within the 2-week target; potentially leading to >1000 avoidable strokes. If surgical capacity is doubled after 1-month of resuming normal service, it will still take more than 6-months to clear the backlog, and 30.8% of patients will not undergo surgery within 2-weeks, with an average wait of 20.3 days for the proceeding 2 years. Conclusions This case study for carotid endarterectomy has shown that every healthcare system is going to have to make difficult decisions for balancing human and capital resources against the needs of patients. It has demonstrated that the timing and size of this effort will critically influence the ability of these systems to return to their baseline and continue to provide the highest quality care for all. The failure to sustainably increase surgical capacity early in the post-COVID-19 period will have significant long-term negative impacts on patients and is likely to result in avoidable harm.
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Clarke et al. (2020) studied Carotid artery stenosis requiring endarterectomy (n=7,696). Increased surgical capacity scenarios vs. Return to baseline capacity with no additional capacity was evaluated on Mean waiting time for patients newly requiring carotid endarterectomy. Simulation modeling shows that even if surgical capacity is doubled one month after resuming normal service, 30.8% of patients will still not undergo carotid endarterectomy within 2 weeks.
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