Dear Editor
The COVID-19 pandemic exposed the fragility of elective surgical and anaesthesia services, resulting in millions of operations being cancelled across the world1. As health systems plan post-COVID recovery of elective surgical services, they should identify potential future external risks to surgical services2. Extreme weather events resulting from climate change could present an increasing challenge to healthcare systems3; surges in injuries and cardiorespiratory complications during heatwaves could reduce capacity to deliver elective care4. The aim of this study was to determine the impact of summer pressures on the delivery of elective surgery in the UK.
The authors conducted a cross-sectional survey of surgeons, anaesthetists, and critical care doctors who worked during the UK heatwave of 16–19 July 2022. A total of 271 responses were received from across 20 specialties in 140 UK hospitals. One in five respondents (50 of 271, 18.5 per cent) reported that the heatwave directly resulted in the cancellation of elective surgery. A further third (96 of 271, 35.1 per cent) anticipated that cancellations were likely in the event of a prolonged heatwave. Factors contributing to heatwave-related cancellations included staff shortages (reported by 35.8 per cent of 271 respondents), unsafe theatre environments (30.3 per cent), and bed shortages (22.1 per cent) (Fig. 1).
Factors contributing to heatwave-related cancellations of elective surgery
*IT problems caused by the heat, patients unwilling to have surgery owing the heatwave. ER, emergency room.
Surgical services were poorly prepared for heatwaves. Ambient temperature could not be controlled in 41.0 per cent of operating theatres. Most hospitals (119 of 140, 85.0 per cent) lacked summer pressure plans to maintain elective surgical safety and capacity. Some 96 respondents (35.4 per cent) reported making adaptations to maintain the routine surgical activity during the heatwave (Table S1).
These data demonstrate that even short heatwaves may result in widespread disruption to surgical services. As hospitals tackle post-COVID surgery backlogs5, they must consider how to safeguard against further climate change-related disruption to the delivery of surgical services. This should be included in the preparation of summer pressure plans to improve the resilience of elective surgery services.
Collaborators
GreenSurg Collaborative: Maria Picciochi, James C Glasbey, Elizabeth Li, Sivesh K Kamarajah, Dmitri Nepogodiev, Joana FF Simoes, Aneel Bhangu, Arjun Nathan, Nizar S M Ismail, Amer J Durrani, Fanourios Georgiades, Ignatius Liew, Mamun D Dornseifer, Chetan D Parmar, Angelos G Kolias, Efstratia A Baili, Ashwani Kumar Nugur, Erminia Albanese, Marios Ghobrial, Andreas K Demetriades, Joseph P Attwood, Baljit Singh, Ciaran M Barlow, Sheila M Fraser, Manas K Dube, Avinash Aujayeb, Dinesh K Thekkinkattil, Abraham J Botha, Tosin O Akinyemi, W K E Peng, Salah A Hammouche, Muyed K A Mohamed, Mahmoud K A Elmesalmi, Maria G Cannoletta, Kai Yuen Wong, Hassan MT Fawi, Suk F Cheng, Funlayo O Odejinmi, Hugo RM Layard Horsfall, Nikolaos Machairas, Rory C Cuthbert, Shahbaz S Malik, Rory G Callan, Richard J Egan, Nader N Moawad, David W Ferguson, Nathan Grundy, Michelle L Collins, Jonathan BT Herron, Chetan Khatri, Sophia E Lewis, Tariq Alhammali, Andrew J Beamish, Kiran K Singisetti, Joseph Shalhoub, Chung S Chean, Rajesh Sivaprakasam, Sreekar Devarakonda, Miles W Benjamin, Sivesh K Kamarajah, James Ashcroft, Pierfrancesco Lapolla, Christin Henein, Baljit Singh, Cillian T Forde, Mohammad Zain Sohail, Rachael J Clegg, Zoe M Seymour, Stavros V Parasyris, Nikolaos Dimitrokallis, Benjamin J Davies, Waleed F A Fahmy, Obafemi K Wuraola, Athanasios Serlis, Binay Gurung, Andrew J Kelly, Rishi Talwar, Paul S Cullis, Dale J Gracie, Markus P Baker, George WV Cross, Wai Wai Win Mar, Raashad Hasan, Dimitri J Pournaras, Cho Ee Ng, Ashok R Ramasamy, Amir N A Iskandar, James C Glasbey, Haaris A Shiwani, Sujesh Bansal, Stephen F McAleer, Omar Ahmed, Nader N Moawad, Umakanth R Kempanna, John-Joe Reilly, Richard J Davies, Sibtain Anwar, Grant A Harris, Usama Ahmed, Kareem T Elsanhoury, Wen Jie Chin, Nikhil Kumar Ponugoti, Javaria Faiz, Amer J Durrani, Mohit Bhatia, Jonathon RC Sheen, Imran H Yusuf, Ziyan Sheng, Grant D Stewart, Shafquat Zaman, Aloka S Danwaththa Liyanage, Karthikeyan P Iyengar, Ravi Aggarwal, Setthasorn Z Y Ooi, Ayesha Mahmud, Mingzheng Aaron Goh, James M D Wheeler, Nicola J Eardley, Michael El Boghdady, Delvene Soares, Alexander D O'Connor, Ankur D Kariya, Filip Fryderyk Brzeszczyński, Joshua L Moreau, Abdel Saed, Isobel Pilkington, Devaraj M Navaratnam, Neil A Ryan, Hooman Soleymani Majd, Lamiese Ismail, Hemina B Shah, Akib M Khan, Paul C Nankivell, Waleed Fayez Ali Fahmy, Robert W Tyler, Leandro Siragusa, Syed S Mannan, Giorgio Bogani, Jibran Abbasy, Piergiorgio Solli, Nadine Di Donato, Josh R Burke, Abdul Hakeem, Firas Aljanadi, Alexander J Baldwin, Mohamed Bekheit, Peter P Bobak, Matyas Fehervari, Fabio Barra, Mohamed A Thaha, Nadir Syed, James B Olivier, Khaled A K Mohammed, Kate J Williams, Tatiana Martin, Aman S Coonar, Michael W S Ho, Mark W Yao, Alexandros Konstantinos Charalabopoulos, Porfyrios G Korompelis, Kay Anne Mak, Abdelrahman AA Elsayed, Eve R Hawley, Ahmed Y Azzam, Alan JB Kirk, Ahmed E Sherif, Mostafa K.A Hussein, James A Blair, Yirupaiahgari KS Viswanath, Simon J Cole, Dheeraj S Attarde, Anna Y Allan, Ioannis N Gerogiannis, Shiva Dindyal, Muhammad H Siddique, Saidah Sahid, Jonathan J Neville, David N Naumann, Matthew H V Byrne, Sean MA Garcia, Ali Yasen Y Mohamedahmed, Alan A Askari, Joerg M Pollok, Hani J Marcus, Kapil Sahnan, Mohamed A Thaha, Qamar Mustafa, Ruben P Thumbadoo, Angelos G Kolias, Ketan Agarwal, Sean Khedar Ramcharan, Mehran Lashari, Mostafa EA Abdelkarim, Toby M Noton, Bilal H Kirmani, Robert D J Whitham, Sofia Anastasiadou, Rute S S Castelhano, Sanad Saad, Gakul Dr Bhatta, Chetan D Parmar, Antonio Leyte Golpe, Rucira Ooi, Emily C M McKenzie, Kenneth N Linton, Khalid M Bhatti, Shyama S Chadha, Liam N Phelan, Alvaro Bedoya Ronga, Vladislav Kutuzov, Mohammed Jibreel Mohammed, Sharan H Sambhwani, Catrin Sohrabi, Raghavan Vidya, Jaskiran K Gill, Lisa S Rampersad, Bincy Merin Zacharia, Waheeb A K Al-Azzani, Omar Pathmanaban N Pathmanaban, Rachel Sarah Olive, Fahad S Hossain, Jessica Harvey, Naren K Kumaran, Annamaria Minicozzi, Andrew Neil Wheelton, Victoria A Evans, Andrew D Beggs, Omar M Ismail, Chandra Shekhar Biyani, Shaikh S Seraj, Mohammed Deputy, Eltayeb B E Shammeseldin, Wafi Mohammed W M Mohammed, Mohamed Onsa, Yizhe Lim, Ahmad Riyadh Abdulsaheb Al-Shaye, Mujahid Gasemelseed Fadlallah, Hash Al-Musawi, Umar B J Yousuf, Safia Zahir Ahmed, Alexandros Laios, Aliabbas Moosa, Zoe Li, Peter J Hutchinson, Abdalla Hassan Abdalla Hassan, Shreya M Kulkarni, Shihab A Chowdhury, Ahmed Y Ammar, Tarig Hassan Ahmed, Raimundas A Lunevicius, Dimitrios Angelou, Edward J Caruana, Panna K Patel, Stephen J Bromage, Panagiotis Kapsampelis, Khaled M Sarraf, Antonios Nicolaos Athanasiou, Jai Relwani, James E Tomlinson, Amarkumar D Rajgor, Pedram Panahi, Rachael V Collins.
Funding
This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79). James Glasbey is supported by an NIHR Doctoral Research Fellowship (NIHR300175). The funder had no role in study designor writing of this report. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the UK Department of Health and Social Care.
Author contributions
Maria Picciochi, James C Glasbey, Elizabeth Li, Sivesh K Kamarajah, Dmitri Nepogodiev, Joana FF Simoes, Aneel Bhangu conceptualised the study, designed and distributed the study, and provided critical input on the study manuscript. Maria Picciochi was the study lead and wrote the first draft of the manuscript, and James Glasbey and Aneel Bhangu provided senior oversight and editorship. Aneel Bhangu is the overall guarantor. The GreenSurg collaborators completed the assessment for their hospital and reviewed the final manuscript providing critical insight prior to submission.
Disclosure
The author declares no conflict of interest.
Supplementary material
Supplementary material is available at BJS online.
Data availability
Anonymised data available upon request of the writing group, and successful completion of a Data Sharing Agreement through an Application Programming Interface (API) linked to the REDCap data server hosted at Birmingham Clinical Trials Unit at the University of Birmingham.
References
Author notes
Members of the GreenSurg Collaborative are co-authors of this study and are listed under the heading Collaborators.
