It found that, by the end of 2021, around 305,000 fewer operations had been performed than originally expected. This led to the loss of 320,000 healthy life years in 2020 and 2021. To put it another way, the health benefits produced by elective operations were 18% lower than expected. The total number of operations that were postponed or cancelled was higher, but part of the backlog had already been cleared by 31 December 2021.

Postponement of elective operations

This study focused only on postponed elective operations performed in hospitals. These are operations for which a waiting period in excess of one month is acceptable from a medical perspective. The study did not look at emergency operations, such as those performed on cancer patients and traffic accident casualties. These often went ahead during the pandemic.

Further research into consequences of COVID-19 for health

This study highlights part of the overall damage that the coronavirus caused in our society. However, plenty more research is being done on the health effects besides this study. For instance, RIVM is also studying other aspects of postponed healthcare, such as avoiding seeing GPs. (Excess) deaths due to Covid-19 are also being studied. (These reports are in Dutch.)

Making health loss measurable 

The study on postponed operations also shows the health loss for 12 specialisms in which elective operations are performed. This loss means that people can't gain any health benefit from having the operation, or at least not yet. This health benefit is expressed as QALYs.

QALY is a term that is often used in the health sciences to describe health effects. It stands for quality-adjusted life year – or a life year corrected for the quality of this life year. 1 QALY represents a life year in perfect health, while a half or a quarter QALY represents a life year with a significant or even extreme loss of quality of life. 

Health loss for each specialism and treatment

All 12 specialisms in which operations are performed in the Netherlands were included in this study. The table below shows how much health benefit was lost, or in other words, how much health benefit was not achieved compared to what would have been expected under normal circumstances.

The specialisms of ophthalmology, orthopaedics and surgery are responsible for the largest health losses, followed by ENT and plastic surgery.

It is important to realise that comparing these specialisms is not a straightforward matter. There are big differences in terms of the numbers of operations that they perform, and in terms of their ratio of elective healthcare versus emergency healthcare. Which is why it is logical that a specialism with fewer elective operations will produce a lower result for health loss than a specialism that ordinarily performs a lot of elective operations with large observed backlogs at the end of 2021. 

-> The unrealised QALYs for each specialism are presented in sections 3.2 to 3.13 of the research report. These are broken down according to year, medical condition and intervention.

Lessons for the future

Several scenarios for clearing the backlog are outlined in the study, which also looked at the potential effect on overall health loss over the next five years if additional healthcare could be provided for a few weeks a year. For example, increasing the number of operations by 5% for a couple of weeks each year until the end of 2026 could ‘recover’ 19,000 healthy life years.

Outlined scenarios for clearing backlog uncertain

The results of these outlined scenarios are extremely uncertain and should be interpreted as such. Whether or not they will actually come to pass depends on many factors. These may include the development of the virus, the available number of healthcare workers and how healthcare will be organised in future. RIVM has made a number of recommendations on these topics to the Ministry of Health, Welfare and Sports.