Counting the cost of postponed surgeries

As non-urgent surgeries set to resume ‘clinical picture of patients has deteriorated’

With the coming relaxations on Covid-related restrictions, non-urgent surgeries will resume as of February 28 in public and private hospitals – to the relief of many who’ve had to tough it out over the past three months. But what’s unclear is just how much backlog has built up, or the extent of the ‘damage’ done to patients, as one leading doctor hammered the government for its lack of planning.

In early December the health ministry decided the cancellation of all scheduled non-urgent surgeries, and also commandeered bed capacity in private healthcare facilities – measures taken in anticipation of a potential surge in Covid-19 hospitalisations and amid concerns over the then new coronavirus variant known as Omicron.

The decree took effect as of Sunday, December 5. In a statement at the time, the health ministry said patients scheduled for non-urgent surgery would be notified of the new date by the healthcare facility where they would have undergone the operation.

Earlier, non-urgent surgeries had resumed on September 8 after being postponed in mid-July to clear more beds for Covid patients after daily cases rose to over 1,000, threatening to overrun the healthcare system.

The move to postpone such operations was soundly condemned by the patients’ association.

“This is very concerning because two years later, chronic patients and those suffering from issues unrelated to Covid keep paying the price of the pandemic,” said Marios Kouloumas, the head of the association.

The postponement of surgeries should have been the “last resort”, and should not have been implemented at this stage, he added.

The ministry also ordered all private hospitals – whether part of the national healthcare system (Gesy) or not – to accept patients from A&E departments of state hospitals or patients being treated in state hospitals. It’s understood this will continue to be the case beyond February.

Private hospitals had been ordered to keep a bed occupancy limit of 70 per cent, and 60 per cent for their ICUs.

Trying to get a feel for the impact of this ‘closed period’ for non-emergency surgeries in public hospitals, the Sunday Mail reached out to Pambos Charilaou, spokesman for the state health services (Okypy).

“We don’t have data on operations put off or what the backlog is. Frankly, nobody could tell you that – be it from the public or private sectors,” said Charilaou.

Nor was he in a position to offer an educated guess.

Charilaou did say that once non-urgent surgeries resume, efforts will be made – with talks already underway – with unions to get doctors in public hospitals to perform operations in afternoons as well in order to deal with the growing waiting lists.

“As for how many persons’ condition worsened because they had to wait – again it’s hard to know,” he said.
“The main thing is that we can now resume, as the epidemiological situation [with Covid] allows for the freeing up of beds, especially ICU beds.”

Asked whether the postponement had been absolutely necessary due to the coronavirus situation, Charilaou gave an unequivocal yes.

But another official, speaking on condition of anonymity, quipped that “it’s not as if the private hospitals stopped doing these non-urgent operations.”

Soteris Koumas, head of the union of government doctors (Pasyki), likewise could not estimate how many people needing an operation were put on hold during this timeframe.

“But it goes without saying that problems have accumulated…we may not have the data in Cyprus, but studies done abroad show an overall uptick where non-urgent cases turned serious because of the rescheduling due to Covid. There’s no question that the clinical picture of patients has deteriorated here as well.”

Koumas stressed that these delays exact a toll on the healthcare system and on patients alike – dealing with cases that are serious (and which might have been preventable) takes up more resources, both in monetary terms and in terms of human resources.

It also creates problems in the running of hospitals, as the goings-on there are interlinked.

“For example, our ICUs were all the time occupied by Covid patients. Just consider that following a serious operation, the convalescing patient needs immediate transfer to an ICU bed.”

As for those suffering from chronic illnesses, the adjustments to the healthcare system mean they might well get referred to a different specialist because meanwhile their condition has worsened.

Koumas confirmed that unions are in talks with Okypy regarding the possibility of doctors operating in the afternoons come March. Although he said this had been a ‘pilot scheme’ in the works irrespective of the Covid situation.

“Nothing firm yet, we’re discussing it with the government,” he hastened to add.

If a deal were struck, it would be up to doctors to decide to work outside normal time schedules [in the public sector], and if physicians chose to work extra they’d get reimbursed accordingly.

“It’s not easy though…can a doctor work mornings and also put in afternoon shifts?”

It’s also not just a question of a doctor’s readiness to pull in more hours, Koumas said.

“You see, the number of surgeries scheduled daily depends on how many beds are available. And other than that, surgeons need support staff, equipment and logistics…it takes a lot of tight planning.”

The doctor took a swipe at the state health services for not having optimally coordinated the endeavour vis a vis managing Covid as well as non-Covid patients.

“After about two years with the coronavirus, and four or five waves, we ought to have got better at this, better organised. We need an operational plan in place, so that everyone knows exactly what they’re supposed to be doing at any given time.”

According to Koumas, Okypy claimed to have hammered out such a plan but “we’ve never seen it, they’ve yet to present one to us.”

Still, he would not go as far as describing the running of public hospitals as “ad hoc”. Perhaps during the first two coronavirus waves of 2020 things were somewhat hit-or-miss – but the situation has improved considerably since.

“It came to the point where we’ve had to rotate patients for the same bed in a single day.”

A haematologist himself, Koumas says he has worked non-stop throughout the Covid pandemic, especially seeing to leukaemia patients who could not be left unmonitored.