This project will run from March 2021 to February 2022.

  • Led by the London School of Hygiene and Tropical Medicine, in partnership with Royal Devon and Exeter NHS Foundation Trust, University College London, and the Universities of Bristol, Nottingham and Glasgow.
  • Research on the effectiveness and cost-effectiveness of emergency surgery versus conservative management, to inform decision-making during the COVID-19 recovery period.
  • Will use data on emergency admissions for acute conditions during the COVID-19 pandemic, alongside discussions with clinicians and patients.

Many patients with common acute conditions, such as appendicitis, are admitted to hospital in an emergency. Some patents have emergency surgery, but others receive ‘conservative management’, which includes the possibility of later surgery. For many patients, it is unclear whether the benefits of emergency surgery are greater than the risks.

Following the COVID-19 outbreak, planned surgery in the NHS was cancelled. As a result, NHS waiting lists are now approaching 10 million patients. The NHS urgently needs evidence to inform which patients should be prioritised for emergency surgery. Information for patients on the risks and outcomes of emergency surgery must recognise the impact of COVID-19.

This research study will assess the effect of COVID-19 on access to emergency surgery for different patient groups, and will report on the effectiveness and cost-effectiveness of emergency surgery versus conservative management following the COVID-19 outbreak. Evidence-based recommendations, which can be quickly incorporated into NHS guidelines, will be developed on which patients should be prioritised for emergency surgery in the COVID-19 recovery phase.

The project team will use Hospital Episode Statistics (HES) data on emergency admissions to NHS hospitals for acute conditions during the COVID-19 pandemic, and discussions with clinicians and patients will provide insights about the impact of the pandemic on decisions made about emergency surgery versus conservative management.

The analysis will look at emergency hospital admissions for five acute conditions where there is clinical uncertainty about which patients should have emergency surgery: acute appendicitis, cholelithiasis, diverticulitis, acute (groin) hernia and intestinal bowel obstruction.


For more information about this project, please contact Richard Grieve, Professor of Health Economics Methodology, London School of Hygiene and Tropical Medicine.

More about the programme


COVID-19 Research Programme


The Health Foundation has launched a new research programme, which seeks to understand the impact of...

You might also like...


Webinar: Build back fairer: Inequalities and COVID-19 in England


To launch the COVID-19 and health inequalities report, the Health Foundation and the UCL Institute...


The impact of Extensive Care Service and Enhanced Primary Care in Fylde Coast


This briefing explores IAUs evidence on how multidisciplinary teams may increase emergency hospital...

Newsletter feature

What can COVID-19 teach us about how to rebuild a more equal society?

Newsletter feature

Fozia Irfan, an expert advisor for our COVID-19 impact inquiry, on how the pandemic is both exposing...

Kjell-bubble-diagramArtboard 101 copy

Get social

RT @AnitaCTHF: Health is the key to rebuilding our economy - the cost is huge but the impact of not spending almost certainly even bigger -…

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more