Getting back to Theatre in Covid-19 Times

30 Jun 2020

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Covid-19 changed everything; we went from routine to chaos overnight. Hospitals and clinics in the UK were grossly affected, and our theatres were eerily quiet.

The priority with the acute services became Covid-19 and increasing capacity and staff to fight the pandemic.

Patients planned surgeries were cancelled, postponement of routine procedures and a complete halt to minor elective surgeries became the norm. Even when the procedure could go ahead, patients were afraid to venture and so stayed at home. Never were the UK theatres so silent to routine operations.


What is happening now with Elective Surgeries?

Now, however, as we exit Lockdown, slowly, safely, and surely theatres begin to hear the militant rhythm of the army of surgeon’s clogs marching up the corridors towards the operating theatre again.

Things are getting somewhat back to a ‘new normal’, patients are returning for their procedures, and elective surgical operations are taking place across the UK again. The backlog of electives is colossal, but under the guidance of the Royal College of Surgeon’s (RCS), and National and local recovery plans, the waiting list can be tackled safely and effectively.


What the data is saying

A recent article by the CovidSurg Collaborative estimates that the worldwide number of elective surgery cancellations could be peaking at 28.5 million operations for 12 weeks of Lockdown. If countries were to increase their average surgical work volume by 10% post-pandemic, the median time required to clear the backlog would be 90 weeks. An increase of 20% would take a median of 45 weeks, and an increase in volume by 30% would take a median of 30 weeks.2 A long road ahead playing catch up. Financially also, this ‘catch-up’ won’t come cheap, with the total cost of clearing the backlog over £2 billion.2

This information highlights the importance of a clear and well-defined strategy in the recovery plans for elective surgery in the UK. 1 Such a plan was recently published by the RCS.


Restarting your Operating Theatre – Useful Guidance form the RCS.

The RCS has developed and published its recovery plan to support surgical teams returning to their theatres. The plan and guidance can be found at, and it supports the surgeon and their team by providing the key considerations and recommendations to effectively and safely take on elective procedures. Nine themes are identified in the plan allowing services to deliver safe patient care and ensure elective surgeries do not have to stop again should Covid-19 surge in the coming months.

The nine themes underpin and structure the plan and can be found on

1. Key considerations before resuming elective services
2. Developing cohesive leadership and process of frequent communication
3. Assessing surgical workload and patient population
4. Ensuring adequate hospital capacity and facilities
5. Enhancing workforce capacity
6. Reconfiguring services
7. Supporting the surgical workforce
8. Patient communication
9. Supporting training


An interesting perspective to resuming elective procedures

Clearly, a huge concern is safety and lowering infection rates and risks. Ideally, all surgical patients would be cared for pre- and post-operatively in non-COVID hospitals or at minimum, low COVID units. However, this is not always possible nor feasible, and so The British Orthopaedic Association has recently published a very interesting guide on restarting non-urgent services after the pandemic.

One of the key concepts was the separation of patients along COVID-free (green) and COVID-managed (blue) pathways. These green zones will further subdivide into ‘Gold’, ‘Silver’ and ‘Bronze’ criteria, with the Gold criteria being an entirely separate COVID-free hospital. The Silver criteria and Bronze criteria to have a COVID-free building or unit separated from the rest of the hospital. It is within these green zones that routine and elective non—urgent procedures should be planned to go ahead, especially higher-risk procedures. 2


The Future of Elective Surgery in the UK

There is no doubt that a challenging time lies ahead. Long waiting lists and backlogged systems face all hospitals and private clinics for some time to come. However, with useful guidance, planning, and communication between national and local authorities, those waiting lists will decrease. A fundamental strategy going forward will structure both recovery and patient care. Perhaps in this case, slow and steady will win the race.



References and Sources

  1.  Nepogodiev D., Bhangu A., CovidSurg Collaborative Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br. J. Surg. 2020 DOI: 10.1002/bjs.11746. Online ahead of print. Available at: Downloaded June 23 2020.
  2. Amin, P.,  Mehr, S., Recovery of non-urgent surgery – Operation backlog and proposals for a restart. Int J Surg. 2020 Jul; 79: 330–331. Published online 2020 Jun 8. DOI: 10.1016/j.ijsu.2020.05.086  Available at


Imperial College Healthcare NHS Trust, UK






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