Orthopedic surgeons say it may be impossible to “catch up” on all delayed operations due to Covid-19 restrictions.
They caution that some patients have already waited too long and may suffer lifelong effects.
The Auckland District Board of Health could not say how many appointments and surgeries were canceled due to the most recent closure, but confirmed that elective operations during level 4 were only about 40 percent of usual, compared to the same period. from last year.
Orthopedic surgeon Peter Robertson said Auckland Hospital had only been treating the most serious cases.
However, patients who were stuck at home in pain ended up costing the healthcare system more in the long run, he said.
“There is little doubt that the longer you are immobilized, the more sick people become, they become less physically active, their ability to rehabilitate to the optimal position that they could have had if they had had their intervention at an earlier stage is much lower.
“It has a continuous flow effect.”
While the number of operations performed increased each year, they were primarily acute or emergency, and the number of elective procedures had decreased, even before Covid-19, he said.
“The concept that the backlog of work could ‘catch up’ is a false concept. There are no staff at all levels of the hospital, there are no beds and there is no infrastructure to do that.”
During Auckland’s five-week lockdown, the Manukau County Board of Health was forced to cancel around 5,000 outpatient appointments and more than 1,150 elective operations.
At the Waitematā District Board of Health, 150 operations a week had to be canceled under alert level 4 and the entire 40-bed Elective Surgery Center at North Shore Hospital was turned into a Covid-19 ward.
The president of the Orthopedic Association, Wellington surgeon Peter Devane, said that Covid-19 had complicated what was already “a resource-poor system.”
“I’m sure the Ministry of Health will recognize this: There is no such thing as ‘catch up’ anymore. We can’t catch up, orthopedic surgery will never be able to catch up, and that phrase needs to be erased from our vocabulary, just because there is no capacity to do that. “
Last year, the government allocated an additional $ 282.5 million to district health boards over three years to eliminate the delay of deferred elective operations.
However, Devane said public hospitals were nearly 100 percent full before the pandemic.
“Who is going to do it? That’s my question. We don’t have the staff, the capacity, the theaters, the surgeons, the nurses, the anesthesia technicians, the ward nurses, the ER doctors, or anyone else who can do it.
“Look at our situation where everyone is doing pretty much everything they can do, and there’s no one else I can call to catch up.”
Postponements ‘not the right answer’
The Executive Director of the Association of Private Surgical Hospitals, Richard Whitney, said they had learned from the previous shutdown that postponing everything “was not the right answer” and that some elective procedures had continued, even below level 4.
Therefore, he was hopeful that the impact of the latest restrictions would not be as bad as last year, but admitted that the increase in waiting times meant that the conditions of some patients would have deteriorated.
“Elective surgery still has priority items. Certainly there are consequences for patients where postponements or delays extend beyond what is best indicated, and outcomes for some patients who are postponed will be suboptimal.”
So, with the public system stretched beyond capacity and less flexibility in the private system to compensate, what is the solution?
Auckland surgeon Peter Robertson said there was something all New Zealanders could do.
“Vaccination should be essentially mandatory. We will not keep people out of the hospital if they are not vaccinated.”
“Even if we get to the high vaccination levels that we aspire to (90 percent), the numbers I’ve seen would suggest that among unvaccinated people, the percentage of them who got sick would still crash our system.”
As Britain, Australia and the United States have already experienced, that would be “the death blow” for anyone undergoing elective surgery in New Zealand, Robertson said.