At the beginning of the 2020 coronavirus pandemic, hospitals and health-care systems reassigned staff, facilities, and supplies away from nonessential services to cater to the rising number of COVID-19 patients. During that time, many elective surgeries were postponed until resources became available again and safety protocols were established. This situation has resulted in a growing backlog of postponed elective surgeries that has to be managed now, as elective surgery is re-emerging, and in the foreseeable future.
A Johns Hopkins University research team headed by Amit Jain used a Monte Carlo analysis model to answer 3 specific questions about the elective-surgery backlog in orthopaedics:
- When will the health-care system return to nearly full capacity for performing elective surgery?
- What will be the extent of the backlog?
- How should health-care systems change to address the backlog?
The authors looked specifically at data regarding inpatient elective total joint arthroplasties and spinal fusions in the US.
Assuming that elective orthopaedic surgery resumed in June 2020 (which it did at some centers), Jain et al. estimated that it will take 7 months in a best-case scenario before the health-care system regains 90% of its pre-pandemic elective orthopaedic surgery capacity. That optimistic 7-month timeframe assumes a “growth velocity” of elective orthopaedic procedures of 50% ± 5%. Achieving that 90% level will take an estimated 12 months with a growth velocity of 30% ± 3%, and 16 months with a growth velocity of 20% ± 2%. Even in the optimistic first scenario, a backlog of >1 million surgeries is expected 2 years after the end of elective-surgery deferment.
The long-lasting impact of the postponement of elective surgeries means that planning to address the backlog needs to start immediately. Jain et al. offer several potentially helpful ideas from the engineering arena that could be translated to health care, including ways to scale up surgical “throughput.” But other notions, such as “queuing and buffering,” could exacerbate existing health care disparities, the authors point out. Whichever tactical approaches to addressing the backlog health-care systems use, the authors conclude that “strategic investments focusing on capacity expansion are crucial.”
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