Postponing operations during the first two corona years has “significant effects” on patients’ health. In 2020 and 2021, more than 305,000 operations have been postponed or cancelled. As a result, an estimated 320,000 healthy life years have been lost. That is what the RIVM calculated. There is a good chance that this loss is permanent, according to the RIVM: only part can be recovered through catch-up care.
About 900,000 ‘plannable operations’ are carried out in the Netherlands every year. These are operations that can wait longer than a month, such as knee, hip and cataract operations. Because the treatment of corona patients has often been given priority in recent years, but also because patients were sometimes infected themselves, some of those interventions were canceled or postponed. Until the end of 2021, this involved at least 305,000 operations, although the total number is higher, because part of the postponed operations before December 31, 2021 has still been made up. RIVM calculated the consequences of this.
The researchers used the QALY (quality-adjusted life year), one QALY equals one year of life in perfect health. For example, someone with cataracts has a quality of life of 0.7 QALY. After surgery, that number goes up.
The RIVM concludes that an estimated 320,000 healthy life years were lost: one fifth of the health gains that would normally have been achieved by all operations. This is an estimate with a wide bandwidth: because the effect of a delayed operation differs in reality from patient to patient. It matters whether you keep a young, fit patient waiting, or someone who is older, with more ailments.
“We think the consequences for health are very large,” says health economist Ardine de Wit, who led the study. “We only looked at planable interventions,” not delayed critical operations, such as cancer treatments, not missed diagnoses. “These are operations that can wait a while. You think: that can suffer for a while. But now you see how great the loss is, and how many people it affects.”
The greatest effect was the postponement of cataract, knee and hip surgeries. For example, in two years no less than 12,000 fewer hip surgeries were performed and 54,000 fewer cataract surgeries.
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The research raises the question of how hospitals should deal with limited operating capacity in the future: how can you best use it now when there is a shortage? Independent treatment centers that also perform hip and knee surgeries performed 20 percent more surgeries in two corona years. Without these interventions, the loss of healthy life years would have been significantly higher (47,000 more years lost). The RIVM concludes that this should happen more often in times of scarcity. The RIVM, which also held talks with doctors, saw that there were “financial barriers” to moving care to those centers – hospitals also earn from those treatments.
Germany could take over patients, the RIVM suggests. And it would be “helpful” if there was agreement among specialties on which surgeries are more necessary than others. RIVM advocates giving priority to operations with greater health benefits. A kidney transplant with a known donor provides more years of healthy life than the removal of a benign mole. “Go back to the surgery emergency lists. We believe that this report provides guidance. Because there will also be a scarcity in healthcare in the coming period.”
Also read: After her postponed open heart surgery, Astrid died in the waiting room of the hospital
A version of this article also appeared in the newspaper of 5 July 2022