Minimising population health loss in times of scarce surgical capacity: a modelling study for surgical procedures performed in nonacademic hospitals

Anouk M.I.A. van Alphen*, Kira S. van Hof, Value Based Operation Room Triage team collaborators, Benjamin Y. Gravesteijn, Eline M. Krijkamp, Pieter A.G.M. Bakx, Peter Langenbach, Jan J. Busschbach, Hester F. Lingsma, Robert J. Baatenburg de Jong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
22 Downloads (Pure)


Background: The burden of the COVID-19 pandemic resulted in a reduction of available health care capacity for regular care. To guide prioritisation of semielective surgery in times of scarcity, we previously developed a decision model to quantify the expected health loss due to delay of surgery, in an academic hospital setting. The aim of this study is to validate our decision model in a nonacademic setting and include additional elective surgical procedures. Methods: In this study, we used the previously published three-state cohort state-transition model, to evaluate the health effects of surgery postponement for 28 surgical procedures commonly performed in nonacademic hospitals. Scientific literature and national registries yielded nearly all input parameters, except for the quality of life (QoL) estimates which were obtained from experts using the Delphi method. Two expert panels, one from a single nonacademic hospital and one from different nonacademic hospitals in the Netherlands, were invited to estimate QoL weights. We compared estimated model results (disability adjusted life years (DALY)/month of surgical delay) based on the QoL estimates from the two panels by calculating the mean difference and the correlation between the ranks of the different surgical procedures. The eventual model was based on the combined QoL estimates from both panels. Results: Pacemaker implantation was associated with the most DALY/month of surgical delay (0.054 DALY/month, 95% CI: 0.025–0.103) and hemithyreoidectomy with the least DALY/month (0.006 DALY/month, 95% CI: 0.002–0.009). The overall mean difference of QoL estimates between the two panels was 0.005 (95% CI -0.014–0.004). The correlation between ranks was 0.983 (p < 0.001). Conclusions: Our study provides an overview of incurred health loss due to surgical delay for surgeries frequently performed in nonacademic hospitals. The quality of life estimates currently used in our model are robust and validate towards a different group of experts. These results enrich our earlier published results on academic surgeries and contribute to prioritising a more complete set of surgeries.

Original languageEnglish
Article number1456
JournalBmc Health Services Research
Issue number1
Publication statusPublished - 30 Nov 2022

Bibliographical note

Funding Information:
Eline Krijkamp was supported by the Society for Medical Decision Making fellowship through a grant (GBMF7853) by the Gordon and Betty Moore Foundation, Palo Alto, CA, United States. Support for this study was solely from institutional and/or departmental sources.

Publisher Copyright:
© 2022, The Author(s).


Dive into the research topics of 'Minimising population health loss in times of scarce surgical capacity: a modelling study for surgical procedures performed in nonacademic hospitals'. Together they form a unique fingerprint.

Cite this