The Operating Theatre Journal March 2022

Nothing routine about routine operations
The BBC recently reported that, as of the end of November 2021, more
than six million people were waiting for routine operations in the UK.
This was the first time this figure had been hit in the history of the NHS
and demonstrated the scale of the backlog in routine operations caused
by the COVID-19 health crisis and its knock-on effect on the wellbeing of
the nation.
The number – which represents not far short of ten percent of the entire
UK population – covered a reporting period before the Omicron variant
of COVID-19 threw the NHS under additional pressure over the festive
period. The next reported number is likely to be higher still.
An international fight for healthcare
Pre-pandemic, the UK Government aimed to offer those that needed nonurgent
surgery a procedure within 18 weeks. In 2018, it was reported that
hospitals achieved this around 88 percent of the time. This demonstrates
that, even before COVID-19, many patients were waiting a significant
amount of time for surgery.
This is not an issue unique to the UK. Research conducted by the
Organisation for Economic Co-operation and Development (OECD)
suggests that waiting times for “elective” or non-emergency surgery have
increased across the economies surveyed, with median wait times for
cataract surgery averaging 92 days. For hip replacement, it was 113 days,
and for knee replacement, it was 189 days. In Poland, patients can wait
almost 250 days on average for cataracts surgery, while in Estonia hip
replacement patients are waiting on average 282 days2. The healthcare
crisis is a global phenomenon.
Magnifying existing issues
In 2020-2021, The King’s Fund – an independent charitable organisation
working to improve health and care in England - reported that the United
Kingdom spent £192 billion on health and social care. This was some £50
billion more than the previous year and represents approximately 10.2
percent of the country’s GDP. This is by no means out of sync with other
countries. Indeed, it is close to the average figure reported by the OECD.
Despite this increase in spending, and the NHS vastly increasing the
number of tests and treatments offered in the summer of 2021 in response
to the COVID-19 backlog, elective surgery waiting lists continued to rise.
The reality is that the COVID crisis has brought into sharp focus an issue
that has developed over decades. The global population has been growing
older and living longer and the proportion of people retired, compared
to those in work, has increased exponentially. Across the world, whether
countries deploy a national healthcare service or not, the demand for
healthcare is growing just as the number of people that are in work and
can pay for it is falling.
The pandemic has acted as a perfect storm to accelerate these issues,
with overstretched healthcare workers having to focus on the immediate
crisis at the cost of the wider wellbeing of the population. Furthermore,
the nature of the virus has led to thousands of healthcare workers having
to isolate for periods to avoid this risk of further transmission, leaving less
people to carry out both routine and emergency procedures.
The burden of delay
For each of the six million people on a waiting list in the UK, there is
nothing routine about their condition. Patients waiting for a cataract
operation suffer with sensitivity to light and glare as well as clouded,
blurred or dimmed vision. They may struggle to see well at night. This
can impact people’s ability to work and therefore support themselves
and their family. Those waiting for a hip or ankle replacement can be in
constant pain. Many are unable to walk, leading to issues around lack of
social contact and independence.
The burden of delay is not limited to the individual. If people are unable
to work because of their condition, they may require increased access to
benefits systems, adding to the overall national cost of a condition. If
their condition means reducing their working hours, they will be paying
less taxes. They are likely to need more GP and hospital appointments.
Prolonged delays to surgery may lead to other conditions such as obesity
through lack of movement or mental health issues caused by loneliness.
While a hip replacement operation may cost somewhere between £10,000
to £15,000, it is not unreasonable to estimate the total impact on the
economy of such an operation as comfortably double this – and grows as
delays increase.
This is not to say that healthcare systems are not doing everything
they can to reduce this burden. Healthcare professionals have a history
of challenging the status quo to improve patient outcomes. Surgery
techniques have radically changed to deliver better healthcare outcomes
and doctors are constantly looking to speed recovery to avoid issues of
bed blocking and increase the volume of elective operations.
Innovation breeds new solutions
Perhaps the biggest opportunity to address these challenges to healthcare
systems’ capacity comes in combining technology with medicine in a bid
to generate better patient outcomes.
The medical technology (MedTech) sector has seen substantial growth
in recent years – a trend that is expected to continue. The European
medical technology market is estimated to be worth more than £102.5
billion, with Germany, France, and the United Kingdom leading the way
in research, development, and implementation of new medical devices.
Indeed, prior to the pandemic in 2019, the total annual revenue of
the global MedTech industry stood at £370.9 billion — representing an
increasing share of the overall global healthcare sector. By 2025, the
global medical devices industry is expected to reach a valuation of
£440.5billion, growing at an average of 5.4 percent per year.
This trend has been accelerated by the pandemic. As COVID-19 challenged
the traditional healthcare processes it forced healthcare systems to
quickly implement new solutions, such as tele-consultations and the
increased use of remote monitoring to manage patients. This helped
demonstrate the transformative potential of technology to healthcare
systems.
MedTech can have a significant impact driving transformation around
how care is provided, enabling healthcare professionals to focus on the
critical. For example, remote monitoring can provide doctors with alerts
that inform them of patients’ vital signs, but healthcare professionals will
still need to interpret these.
Faster recovery, more capacity
One of the areas with most potential is MedTech devices that empower
patients’ faster recovery. Devices that reduce swelling, for example, or
heal wounds more quickly, can enable patients to manage an increased
part of post operative recovery at home. This has several positive
outcomes. For the healthcare system, reducing time spent in hospital
recovery reduces bed blocking and can free up extra capacity to perform
more operations.
Faster recovery after surgery also reduces the risk of patient complications.
Immobile patients are at a higher risk of blood clots, known as venous
thromboembolism (VTE). Around 55 – 60 per cent of all VTE cases occur
during or following hospitalisation , resulting in approximately 25,000
deaths in England each year alone.
Sustained time in hospital can also increase risk of infection. According
to the World Health Organisation, healthcare associated infections are
the most frequent adverse event in healthcare delivery worldwide. 10
percent of patients in developing countries and seven percent in developed
countries will acquire at least one healthcare associated infection during
their time in hospital. Perhaps most importantly, patients that are using
MedTech devices to hasten recovery are playing a significant role in their
own wellbeing.
MedTech empowering improved patient wellbeing
Like many industries, COVID-19 has turbo charged a trend in healthcare
that was already manifesting. Hospital waiting lists for routine operations
were growing before the pandemic, but the impact on the healthcare
crisis has hastened the need to generate meaningful positive change. If
any positive has come from the pandemic it is that change that would
ordinarily have taken a decade has been implemented in weeks or months.
The challenge now is to create healthcare systems that can address not
only current needs, but future ones and effectively manage the backlog
of elective surgery. The MedTech industry has a critical part to play
in delivering the ingenious solutions that will help healthcare systems
manage demand today and tomorrow.
REFERENCES
BBC News. [Internet]. 2022. https://www.bbc.co.uk/news/health-59972628
The Guardian. 2018. Available from: https://www.theguardian.com/society/2018/jul/13/nhsoperation-waiting-lists-reach-10-year-high-at-43m-patients
World Population Review. [Internet]. 2021. https://worldpopulationreview.com/countryrankings/health-care-wait-times-by-country
The King’s Fund. [Internet]. 2022. Available from: https://www.kingsfund.org.uk/audio-video/
key-facts-figures-nhs
NHS England. [Internet]. 2021. Available from: https://www.england.nhs.uk/2021/09/nhsdelivers-millions-of-routine-treatments-in-toughest-summer/
SRG Talent. [Internet]. 2021. Available from: https://www.srgtalent.com/blog/why-vcs-arerushing-to-invest-in-medtech-innovation
Thrombosis Statistics. [Internet]. 2018 [accessed 2018 Oct]. Available from: https://www.
thrombosisuk.org/thrombosis-statistics.php
House of Commons Health Committee. The prevention of venous thromboembolism in
hospitalised patients. London: The Stationary Office. [Internet]. 2005 [accessed 2018 Oct].
Available from: https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/99.
pdf
World Health Organisation. Health care-associated infections. Available from: https://www.
who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
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