The Changing Landscape for Surgeons

With the overload of persistent Covid-19 emergencies, surgeons have found it increasingly difficult to have stability in their operational lives. The balancing act of their usual day to day surgical procedures has become a huge problem and many, including surgical trainees, have been seconded to other departments to cope with the increased workload. NHS surgeons and other key medical personnel are not able to do the jobs they were trained for and many surgical issues have come to a grinding halt.

Are certain types of surgery affected more than others?

Routine or elective procedures, as opposed to emergency surgery, have been ‘put back’ for around 6 months, some even for up to a year or more. The goal is to minimise risks and allow for extra bed capacity for those who have contracted Covid-19. The backlog has demanded that surgeons re-programme their already huge waiting lists and prioritise by importance. With the advent of the second Covid-19 wave, even lengthier lists and time delays will not be avoided.

One of the main procedures that is suffering the most is thoracic surgery. With the effect that Covid-19 can have on the respiratory system, it is essential that these patients are in a sterile and protected environment before any surgery can take place. Exposure to any form of virus could be life-threatening for those awaiting surgery in this area. Whilst every care is taken in terms of isolating Covid-19 from surgical in-patients, there is always a potential risk factor. Thoracic operations and treatments are one of the worst hit.

Most concerning, as Professor Michael Griffin, president of RCSEd reported recently, is that there is a 20-30% increase in deaths of patients who have undergone surgery and contracted the virus. He calls for more consistency in testing facilities for surgeons, which he currently believes is not regular enough, and should be conducted at a minimum of once per week, thereby increasing the level of safety for patients. The Royal College of Surgeons also echoes this need for more regular testing.

As an example, Kings College Hospital (KCH) had the following changes to their normal practice, due to the volume of Covid-19 admissions:

-In the cardiothoracic unit (elective), space was used for storage of ICU equipment.

-In the cardiothoracic high dependency unit, space was utilised for Covid-19 positive ICU. More space was also adapted here for changing in and out of PPE.

-Surgical staff were informed that they may be likely to be seconded to Covid-19 wards to assist and support in roles that they were unfamiliar with, including some ‘nursing’ duties, irrespective of their current positions. This was with the agreement of the staff concerned as long as any existing health problems they already had did not put their wellbeing at risk.

These types of changes were recognised by other hospitals as an essential move to cope with rising cases and life-threatening implications of Covid-19.

Surgeons call for ‘ring-fencing’ for current and future pandemics

In a recent survey by The Royal College of Surgeons (RCS) in which 1,000 surgeons participated, many expressed the need for ‘ring-fencing’ of hospital beds for scheduled surgical procedures. This would hopefully cut down on the deluge of operations being cancelled due to Covid-19 cases which are rapidly escalating.

Surgeons are finding it increasingly difficult to meet the targets set for the NHS to play ‘catch up’. Most are falling behind, particularly in the larger hospitals with heavy rates of virus cases. Some of this is due to the delay in getting results from testing, but also the lack of sterile operating facilities and secure bed space. NHS England requested that surgeons bring their pre-Covid operating levels up to 80% in September, rising to 90% in October. These figures are not being hit by the majority of surgeons who participated in the survey. Some are as low as less than 50%. So, it seems like an insurmountable task.

What are surgeons’ other concerns?

Surgeons have many concerns during this time, as the British Journal of Surgery (BJS) reports, both for the immediate and long-term effects of delayed surgery and patient care. With ‘no end’ currently to be seen for the total eradication of the virus, their main concerns are:

-Surgical procedures that would normally have been simple and with a high rate of effectiveness are being delayed. This could result in a patient’s condition worsening, leading to a more complicated operation and longer recovery period. The possibility of further surgery has also increased, and lengthier perioperative care is a distinct possibility.

-Making decisions as to which patients should be treated first when there is such a lengthy list.

-The question of when certain surgical procedures will be re-established post-pandemic. As yet, no definite plans are set out for resuming surgical services, either by the WHO, NHS England or the UK Government. Hospital Trusts are very much on their own with this, with information being purely anecdotal.

-Receiving adequate back up from other departments that are integral to surgical procedures, such as anaesthesia, theatre staff and general cleaning staff.

With so many aspects to consider, it will take a long time for surgeons to get back to their normal modus operandi. With all of these complications in mind, we need to spare a thought for the personal effect this may have on the life of a surgeon – not just in physical and mental health, but home life as well. Right now, in resuming their normal day to day surgeries and their focus of helping patients, their hands are tied.