Abstract
ObjectivesThe suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers.DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England.ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018.Main outcome measuresThe identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.
Highlights
The COVID-19 pandemic put a global halt to the majority of elective surgery in order to manage the surge in patients requiring acute hospital services and intensive treatment unit care.[1,2,3,4]
A total of 7 811 891 planned interventional procedures corresponding to 5 718 031 admissions involving 4 284 925 adult patients resident in England from 1 April 2017 to 31 March 2018 were identified. These procedures were performed at 530 National Health Service (NHS) hospital sites and 162 different private provider sites
Twenty-eight types of procedure in table 2 accounted for 3 907 474 operations, over half of all planned surgical procedures during the study period
Summary
The COVID-19 pandemic put a global halt to the majority of elective surgery in order to manage the surge in patients requiring acute hospital services and intensive treatment unit care.[1,2,3,4] It has been estimated that 28 million elective operations worldwide have been cancelled or postponed due to the pandemic.[5] the focus of public health organisations globally was rightly mounting an effective emergency response to the COVID-19 pandemic, the surgical ‘aftershock’ will be unprecedented and yet to be fully appreciated. Millions of patients in the UK are already waiting for treatment. Numbers increase daily as the diversion of resources continues.[6] Elective surgical services are gradually being reintroduced, aiming to treat waiting patients without risking the spread of COVID-19. An immediate response to ‘catch up’ and clear case load will need to be undertaken, as well as adjusting to a ‘new normal’
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