How UW Medicine, Mayo Clinic + others are tackling a backlog of surgical cases

More than 18,000 procedures were postponed at Seattle-based UW Medicine, and as of March 1, Indianapolis-based IU Health identified at least 5,000 to 6,000 surgical cases in its backlog.

These numbers are not uncommon, as many hospitals and practices have delayed nonurgent surgeries during surges to make space for COVID-19 patients and focus all resources on fighting the pandemic.

U.S. hospitals saw a 35 percent decrease in operating room volume from March to July 2020, according to a McKinsey report. Many patients were left in limbo, unsure as to when their day for surgery would come.

"The impact on surgery is incredibly broad," Patricia Turner, MD, executive director of the American College of Surgeons, told NPR in February. "It's going to be felt for a long time."

Working through the backlog

As the latest COVID-19 surge has died down, many hospitals are now tackling the mountain of backlogged surgeries. 

Paul Calkins, MD, vice president and associate chief medical executive of IU Health, said in addition to the system's surgical backlog there's also a similar backlog of gastrointestinal endoscopies. Additionally, he identified backlogs in interventional radiology and the health system's cardiac catheterization labs, although he couldn't provide firm numbers for those.

Amid the backlog of surgeries, IU Health continues efforts to reduce the number, while also performing other ongoing care.

"There's still ongoing care that develops every day, so if we even went back to 100 percent of our pre-pandemic production, we still couldn't catch up our backlog because that's just ongoing care we're still providing," Dr. Calkins said. "So, we need to come up with a strategy to increase above our normal surgical capacity, and like every other hospital probably in the U.S., we've taken losses in staffing — both physician and nonphysician, so it's going to be difficult for us to make up all of those losses."

Dr. Calkins also pointed to the high patient volumes the health system is experiencing, even with its COVID-19 census declining.

"That's almost certainly a reflection of delayed care over the last couple years. Even without catching up our surgical volume, we're dealing with historically high inpatient census numbers, so it's going to be very difficult, and I don't know that we've finalized how we're going to make it yet. We're still working our way through. Some of our [16] hospitals have managed to essentially turn back on their flow of surgeries and take a run at it, but others have not yet made that leap. Everyone's resumed surgery, but not everyone is at full yet," he explained.

As hospitals across the country tackle surgeries delayed during the pandemic, there are various challenges. For example, many people have had their procedures delayed for months. Therefore, their preoperative evaluations have expired, their medications may have changed, and they need to go back and see their primary care doctor or a perioperative clinician to ensure they're adequately prepared, Dr. Calkins said. Taking time off work is also a factor people must consider before they have their procedure.

"All of these things are exceedingly complex. … It takes a remarkable amount of work to spin surgery back up just from the logistics of long delays like this. Plus, many of them have seen extensions of their pathology, which means that the care they require is more complicated than it would have been if we had gotten to them in a timely manner," Dr. Calkins said.

Strategies to close the gap 

At Seattle-based UW Medicine, where 18,000 procedures were postponed during the pandemic between April 2020 and December 2021, the system is trying to analyze how far into their backlog they've gotten so far.

By prioritizing the most time-sensitive cases using expert opinion and expanding operating hours, the system is working through the backlog.

Salt Lake City-based University of Utah Hospital is working through 500 of its backlogged procedures, according to the Salt Lake Tribune. To speed up the process, the hospital brought in a U.S Navy medical team of 20, including physicians, nurses, respiratory therapists and administrators. The Navy team will stay for 30 days, probably too short a time to clear the entire backlog, but enough to make a dent in the list. 

Cleveland Clinic could not provide a firm number regarding the health system's backlog. 

However, "we are already scheduling and doing some of the procedures we delayed," spokesperson Alicia Reale Cooney told Becker's

"Wait times depend on the type of surgery and medical condition of the patient," she added. "Our teams are working to ensure we reschedule patients who had their procedures delayed in a timely way."

Rochester, Minn.-based Mayo Clinic is working through its backlog as well. 

"Over the course of the pandemic, Mayo Clinic has actively managed the volume of scheduled services across ambulatory, procedural and surgical care," spokesperson Kelley Luckstein said. "We have also worked closely with physicians and patients to ensure care occurred in a timely manner and that patients continued to receive the highest-quality care and outcomes."

Financial effects of delayed surgeries

Then there's the financial effects. Healthcare organizations saw revenue from elective surgeries decline, particularly earlier in the pandemic and during subsequent surges, as they held off on these procedures. One study published in May 2021 in Annals of Surgery found that hospitals lost an estimated $20.3 billion in revenue from March to May 2020. 

Hospitals received federal relief aid to help cover expenses or lost revenues tied to the public health crisis.  

Still, "this has not been a good year for healthcare from a financial aspect or most other aspects," Dr. Calkins said.

He said IU Health has had a steady and consistent effort since 2008 to ensure they are insulated against economic shock, and that planning has helped the health system from a financial perspective over the last two years.

And IU Health continues planning today, while working through the backlog of delayed surgeries.

"We have every intention to plan for another surge of COVID cases in the fall," Dr. Calkins said. "Assuming that when it gets cold, we'll probably see COVID come back at least to some degree. That could significantly affect our recovery plans. If we made it to the fall with our backlog completely cleared, I think we'd be doing well and going into the fall and seeing another surge would just set us back again. We're keeping that contingency planning in mind."

"Our priority is the health and welfare of our patients, but the reality is when any hospital encounters a significant reduction in surgical volumes over a 22-month period, there is a financial consequence," said Susan Gregg, a spokesperson for UW Medicine. "We had six COVID-19 surges over the past 22 months."


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