Covid-19 coronavirus: Elective surgeries ramping up after 30,000 operations delayed due to lockdown

Auckland woman Emily Ball, 23, is waiting for surgery to remove endometriosis which gives her excruciating cramps and pain. Photo / Supplied

The nation's hospitals have began tackling the huge backlog of elective surgeries deferred because of Covid-19 .

Thousands of elective surgeries were put on hold during the five-week coronavirus lockdown, leaving countless patients suffering at home with debilitating conditions.

But under level 3 guidelines, DHBs are now starting to resume elective procedures - medical or surgical services that aren't required immediately - in a bid to address a huge wait list of patients that's expected to take 18 months to clear with the help of private hospitals.

The most pressing and non discretionary surgeries such as those for cancer, vascular surgeries or ones that limit someone's quality of life, such as spinal surgeries and neuro surgeries, are now being prioritised.

Under level 3 some planned care, including elective surgery and radiology can be provided at hospitals, while some non-urgent services or treatment may be pushed back, according to the Ministry of Health.

Endometriosis NZ chief executive Deborah Bush said the precise fallout from Covid-related delays was unknown, but the charity had been swamped with feedback and pleas for help.

Before the pandemic struck, delays in women's health services meant many DHBs were prioritising urgent treatment like for cancer, with others needing 'elective' procedures sent away.

They included women with endometriosis, an inflammatory disease where tissue similar to the lining of the uterus is found outside the uterus, often causing debilitating pain.

"The symptoms do not just affect their life and often normal daily function, but impact on their schooling, work, relationships and can have the double-whammy of compromising their fertility," Bush said.

Surgery was needed to diagnose and treat the condition, but the wait for that was years-long in our DHBs - and would now be worse.

Endometriosis NZ, which receives no government funding, had heard from women whose pain was so bad they couldn't work, and a few had said they felt suicidal - including teenagers.

"They feel as though they have lost sight of their own future and were experiencing a sense of hopelessness.

"We went into Covid on the backfoot. Those who were fortunate to be on a list had already been waiting years - in many cases - and to then be told the surgery had now been cancelled with no set date for reschedule has been absolutely numbing. It has been soul-destroying for them."

The Cancer Society is also calling on DHBs to prioritise cancer diagnosis and treatment as new evidence from overseas shows that lockdowns led to half as many cancer diagnoses as usual.

A three-month delay in cancer diagnosis and treatment could result in 400 additional deaths from cancer, the evidence showed.

"While some parts of our health system have been working well during lockdown, fewer people have seen their GP, there has been fewer operations, fewer scans, and fewer diagnostic tests," Cancer Society medical director Dr Chris Jackson said.

"This will mean some cancer diagnoses have been delayed."

The country's only surgical bus is also back operating from today after a six-week hiatus to ensure regional New Zealanders in dire need of elective treatment get the operations they need after their surgeries were deferred .

The bus will be parked up beside Canterbury's Rangiora Hospital for two weeks to treat people who've been patiently waiting at home to get a new surgery date, Mobile Health chief executive Mark Eager said.

Forty elective general and gynaecological surgeries are scheduled for the first week.

New Zealand Private Surgical Hospitals Association president Richard Whitney said private hospitals had already started performing elective surgeries - many of which had been given to them by the DHBs.

Whitney estimated about 30,000 private and public surgeries had been deferred during lockdown. It was not an "insignificant task" to carry those out.

"It certainly creates a level of demand that should see private hospitals and DHBs pretty much at full capacity for some time."

Like public hospitals, private hospitals were operating on the most acute first.

Bay of Plenty District Health Board continued operating on urgent elective surgeries under level 4 and is now starting to tackle semi-urgent surgeries during level 3.

BoP DHB Incident Management Team incident controller Bronwyn Anstis said non-urgent cases were still being deferred, but patients remained on the wait lists.

During alert level 4 Waikato DHB performed more than 2000 acute and elective operations and was gradually increasing the number of elective surgeries it carried out. All cases were assessed based on urgency, expected duration of admission and likelihood of complications requiring high intensity care.

A Waikato DHB spokesperson said fewer patients could be operated on each day due to social distancing protocols.

Currently 15 theatres were operating daily but theDHB planned to have all 26 theatres at Waikato and Thames hospitals running at normal capacity during the next five weeks.

Rotorua Hospital has also started performing elective procedures in all specialities, but there were some limitations with procedures that are high risk of aerosol transmission such as dental and some ear nose and throat operations.

Its theatres were operating at about 30 per cent capacity, but this was expected to substantially increase over the next two weeks .

Wairarapa, Hutt Valley and Capital & Coast DHBs were also carrying out some urgent elective, acute and non-defer able surgery during level 4 and now under level 3.

Director of provider services for Hutt Valley and Capital & Coast DHBs Joy Farley said they were working with private providers to ensure non-defer able planned surgery – such as cancer or cardiothoracic operations – could continue.

"As always decisions around surgery and appointments are based on advice from our clinicians, and the clinical needs of individual patients, and with patient safety and wellbeing as our highest priority."

A Ministry of Health spokesperson said hospitals continued to provide services, prioritised according to clinical need. Photo / 123RF

Canterbury DHB is also restarting surgery and plans to be operating at 85 per cent of the pre-Covid-19 surgery volumes within four weeks.

It was working with local private hospitals to reduce the backlog.

The Northern Region DHBs (Northland, Waitematā, Auckland and Counties Manukau DHBs) were continuing with urgent and acute elective surgeries and planned to gradually restart services.

A spokesperson for the Northern Region DHBs said wait lists were regularly being reviewed so patients with the greatest clinical need were prioritised.

"We never take the decision to postpone planned procedures or surgeries lightly and we are sorry for the uncertainty this creates and any disruption this may cause our patients and whānau."

A Ministry of Health spokesperson said hospitals continued to provide services, prioritised according to clinical need, with a focus on emergency and urgent non defer able care during the "lockdown period" in a way that was safe for patients and staff. The majority of cancer surgeries have continued during this period.

"There is a lot of planning underway both at the national and DHB level. The Ministry is working with DHBs to develop recovery plans and implement strategies to address any increased wait lists due to the Covid-19 outbreak."

DHBs were advising patients whose surgeries had been deferred what steps they should take if their condition worsened during the even longer wait.

'SO MUCH AGONY'

Emily Ball, 23, first discovered she had endometriosis when she was 14.

Every month when her period was due to arrive, the Auckland teenager would be crippled over in pain, vomiting and develop a sweat and chills.

"Sometimes I would hallucinate because the pain was so bad."

She visited a gynaecologist when she was 16 who said while it was the likely cause, they were unable to diagnose it until the end of puberty - about age 21.

Ball then visited about 10 other doctors and their advice was the same - she had to "suck it up" and wait.

Most months she would be in so much agony, she would end up at A&E or her GP.

"My periods were not normal periods."

Eventually, Ball was able to have the surgery and after an eight-month wait was operated on in February this year.

The surgeon was unable to remove all the endometriosis and she was told she would need a second surgery six weeks later - about the same time the country went into lockdown.

The painful recovery from her first surgery took about six weeks including a complication which saw her hospitalised for an extra four days.

As well as the intense cramps she was still experiencing, she was also in limbo and unable to apply for jobs as she did not know when the next surgery would be and had not heard from the hospital.

"If the cramps get really bad then I get quite sick."