Elective surgery before, during and after the COVID-19 pandemic in England 2015 - 2024: A database study

<ns3:p> Background To describe trends in elective surgery volumes over the COVID-19 pandemic and to compare post-COVID with pre-COVID volumes with respect to three hypotheses: 1) higher priority operations would be favoured over operations designated a lower priority; 2) the independent sector would take on a greater proportion of NHS-funded surgeries; 3) the proportion of cases switching to the independent providers would be higher for the areas in the lowest deprivation quintile. Methods We extracted data from the Hospital Episodes Statistics (HES) database from 1 <ns3:sup>st</ns3:sup> April 2015 to 31 <ns3:sup>st</ns3:sup> December 2024. This database contains all emergency and elective patient admissions, outpatient appointments and A&amp;E attendances funded by the NHS in England. We included spells with a selection of primary operation codes from priority groups 3 and 4, as defined by the “ <ns3:italic>Clinical guide to surgical prioritisation</ns3:italic> ”. We described and illustrated time trends for operations in these groups during the pre-COVID, COVID and post-COVID periods. Results In the post-COVID epoch, compared to the pre-COVID epoch, we observed: <ns3:list list-type="bullet"> <ns3:list-item> <ns3:p>1) The number of operations carried out per unit time recovered gradually.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>2) High priority operations increased as a proportion.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>3) The proportion of high priority operations carried out in Independent Sector Healthcare Providers (ISHPs) increased dramatically to almost equal the proportion carried out in NHS owned hospitals. This pattern was not replicated for lower priority operations.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>4) We did not find evidence of discrimination against more deprived IMD quintiles among higher or lower priority operations.</ns3:p> </ns3:list-item> </ns3:list> Conclusions Overall, the number of operations has not yet recovered to its pre-COVID level. We found that a proportion of NHS-funded elective surgery shifted towards the independent sector under high demand. We also found that the service discriminated in favour of higher over lower priority but discrimination between people from least deprived vs. most deprived areas was not observed. </ns3:p>