Millions of elective surgical procedures were cancelled worldwide during the first wave of the COVID-19 pandemic.

This enabled redistribution of staff and resources to provide care for patients with COVID-19 and addressed evidence that perioperative SARS-CoV-2 infection increases postoperative mortality.

Although some hospitals established COVID-19-free surgical pathways to create safe elective surgery capacity,

the National Health Service (NHS) in England has not returned to pre-pandemic elective surgery activity levels.

The NHS faces winter pressures every year but enters this winter in a particularly fragile state.

The emergence of the omicron SARS-CoV-2 variant raises the possibility of rapid increases in COVID-19 admissions and intensified pressure on elective care. We used NHS England activity data from the period following the end of the first COVID-19 wave (ie, from September, 2020, onwards) to estimate how increases in the number of hospital beds occupied by COVID-19 inpatients at any one time might affect elective surgery activity in England over the coming winter months. We calculated the potential shortfall in projected elective surgery activity from December, 2021, to February, 2022, compared to the same period in 2019 before the COVID-19 pandemic.