Hospitals in England and Wales undertook almost 1.6m fewer operations last year because of the pandemic, including on people who needed emergency and urgent surgery, a study shows. People with cancer will die as a result of having to wait for care while the delays will leave other patients less likely to improve after treatment, the researchers say. The authors of a study published in the British Journal of Anaesthesia say their findings are the first to quantify the number of people whose surgery did not happen because hospitals were too busy treating Covid patients. They found that in total 1,568,664 operations fewer than expected went ahead in England and Wales during 2020 and predict that the total will soar to 2.4m by the end of this year. The research is the latest to illustrate how the widespread suspension of normal NHS care during the pandemic affected patients who could not access diagnostic tests or treatment. “The interruption of surgical treatment detailed in our research will be felt by millions of patients for many years to come”, said Tom Dobbs of Swansea University Medical School, the co-lead author of the study, which was funded by the charitable arm of the Barts Health trust in London. “Delays in the diagnosis and surgical management of cancer patients will lead to an increase in deaths, while those waiting for semi-urgent and elective surgery are more likely to experience a worsening of their condition, with some procedures made more problematic and less likely to succeed.” Hospitals were under such pressure last year that the nearly 1.6m cancellations included 108,406 operations classed as emergency surgery – including broken legs, coronary heart disease or appendicitis – that should have been done within three days. In addition 92,420 operations classed as urgent, which hospitals were meant to carry out within 28 days, were not done on time, the academics found. They included people awaiting bowel, lung, breast and testicular cancer surgery, the removal of a brain tumour or repair of an aortic aneurysm. They represented falls of 13.4% and 23% respectively in the number of operations that would have been performed if the pandemic had not struck, based on the levels of surgical activity seen in 2016-19, according to the study. The researchers are from Swansea University Medical School and Queen Mary University of London. Hospitals undertook 904,761 (36%) fewer semi-urgent operations, such as for prostate cancer or removal of a gall bladder, than would have been expected. They also performed 481,150 fewer elective procedures, which include hip and knee replacements, breast reconstructions and hernia repairs – a fall of 52% on the number that would have been expected without Covid disruption. Both types of surgery are supposed to be done within three months of the patient being referred. “It is imperative that surgical patients are not the forgotten casualties of the pandemic”, the authors say. The dramatic falls occurred because of the “necessary trade-off between care of a large volume of patients with acute respiratory disease, many of whom required intensive care treatments, and continuation of services to treat surgical disease”. The academics also found that people in hospital for any sort of surgery who became infected with Covid were six times more likely to die within 90 days than other patients. Lucy Watson, chair of the Patients Association, said the NHS could not undertake more operations during 2020 because it was “in a weak position – underfunded and understaffed”, after years of being under-resourced. “The fact that the cancellations included emergency and urgent operations is really concerning and will have led to poorer health outcomes for patients”, she added. The total number of people on the waiting list for hospital treatment in England has risen in recent months to 5.1m – the highest-ever level – as growing numbers who could not, or were reluctant to, access NHS care during the pandemic belatedly saw their GP and were referred on. On Thursday the health secretary Matt Hancock acknowledged that that total could grow much bigger in the coming months if more people in “the unpresented backlog” seek care. NHS England criticised the findings of the Barts-funded study. An NHS spokesperson said: “This study is wrong to compare the data in this way because actually the reduction in this activity occurred because fewer people came forward for care. This is why the NHS has been running a campaign throughout the pandemic encouraging people to access services when they need to, as normal.”