The Impact of Elective Surgery Postponement during COVID-19 on Emergency Bellwether Procedures in a large tertiary centre in Singapore.

BACKGROUND: The COVID-19 pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for 3 emergency bellwether procedures.

METHODS: A retrospective cohort study of patients who underwent any of the 3 emergency procedures (Caesarean section (CS), emergency laparotomy (EL) and open fracture (OF) fixation) between 1 January 2018 to 31 December 2021 was conducted using clinical and surgical data from electronic medical records. The volumes and outcomes of each surgery were compared across 4 time periods: pre-COVID (January 2018 - January 2020), elective postponement (EP) (February - May 2020), recovery (June - November 2020) and post-recovery (December 2020 - December 2021) using Kruskal Wallis test and segmented negative binomial regression.

RESULTS: There were a total of 3886, 1396 and 299 EL, CS, OF, respectively. There was no change in weekly volumes of CS and OF fixations across the 4 time periods. However, the volume of EL increased by 47% (95% CI: 26 - 71%, p = 9.13 x 10-7) and 52% (95% CI: 25 - 85%, p = 3.80 x 10-5) in the recovery and post-recovery period, respectively. Outcomes did not worsen throughout the 4 time periods for all 3 procedures and some actually improved for EL from EP onwards.

CONCLUSION: Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume for EL after the postponement without any worsening of outcomes.