A recent study published in the The Journal of the American Medical Association reports a 48% decrease in surgical volume after elective procedures were postponed across the United States due to the pandemic. After the lockdown was lifted, surgical volumes returned to pre-pandemic rates.
Austin Surgeons board certified general surgeon Dr. John Abikhaled recently shared insight in an article by Marilynn Larkin on Reuters Health about on how these reported trends compared to what he experienced in Austin. You can read the entire article below.
Surgical procedure volume rebounded to prepandemic rates after falling by nearly half during the initial pandemic shutdown, a retrospective study shows.
“The findings were not surprising to me as a surgeon, but they have been shocking to my medical colleagues and friends,” Dr. Sherry Wren of Stanford University School of Medicine in Palo Alto told Reuters Health by email. “Everyone was told that patients weren’t getting care, yet all of us in surgery were working very hard and, in many cases, more in 2020 than in 2019.
“Personally, I was supposed to have a hand operation in March 2020 when the initial shutdown cancelled all elective surgeries,” she said. “As soon as this was lifted, I called my surgeon to make sure I could be operated on as quickly as possible since the condition was affecting my surgical performance.”
Dr. Wren’s outpatient surgery in May 2020 “was an easy decision since I could go home and not have to take any inpatient resources,” she said. “This is what occurred throughout the U.S. during the next surges, preservation of this type of ambulatory case and limitation of inpatient procedures to urgent or emergent until the local situation improved.”
As reported in JAMA Network Open, Dr. Wren and colleagues analyzed data from a US nationwide healthcare technology clearinghouse to compare surgical procedure volume during the initial COVID-19-related shutdown in 2020, and subsequent fall and winter infection surges, with the 2019 volume.
More than 6.5 million surgical procedures occurred in 2019: 3,516,569 among women (52.9%); 613,192 among children (9.2%); and 1,987,397 among patients 65 and older (29.9%).
The 2020 data included close to six million procedures: 3,156,240 among women (52.8%); 482,637 among children (8.1%); and 1,806,074 among patients 65 and older (30.2%).
During the initial shutdown (i.e., epidemiological weeks 12-18), surgical procedures decreased by 48% – from 905,444 in 2019 to 458,469 in 2020 (incidence rate ratio, 0.52).
Surgical volume decreased in all categories; however, during the initial shutdown, otolaryngology (IRR, 0.30) and cataract procedures (IRR, 0.11) decreased the most among major the categories.
Notably, organ transplants and cesarean deliveries did not differ from the 2019 baseline.
During the ensuing COVID-19 surges, surgical procedure volumes rebounded to 2019 levels (IRR, 0.97), except for otolaryngology (IRR, 0.70).
Further, state volumes of COVID-19 patients correlated with surgical procedure volume during the initial shutdown, but not during surges.
Dr. Wren noted that during the initial pandemic response, hospitals and systems were limiting all elective surgery because of factors such as an unclear supply chain, need to preserve hospital and ICU beds, minimal COVID testing capabilities, and a significant amount of ventilator use.
During the fall/winter surge, systems adapted, she said, largely because PPE was available, as was testing, and ventilator protocols changed to include fewer patients.
“Outpatient elective surgery continued (60-70% of all surgical procedures) during subsequent surges because patients did not need hospital beds,” Dr. Wren said.
Dr. Shereef Elnahal, CEO of University Hospital in Newark, New Jersey, commented on the study in an email to Reuters Health. “Curtailing surgical procedures was necessary to conserve resources and reallocate personnel during the worst of what we experienced in the spring of 2020. However, hospitals have largely been able to respond by stockpiling PPE and refining their staffing plans as COVID cases oscillated thereafter.”
“At University hospital,” he said, “we’ve been able to maintain 90 days of PPE in most categories and staff safely throughout most of the pandemic (surges).”
That said, he added, “Curtailing surgical procedures also comes at a public health cost. We have been seeing non-COVID acuity go up significantly in our community, and our hospital has been at capacity with non-COVID patients for some time now.”
Dr. John Abikhaled of Austin Surgeons in Texas told Reuters Health by email, “The trends described in the study reflect the experience locally in the Austin area.” After the initial shutdown, “during the subsequent viral surge, the need to cancel or delay elective or non-emergency cases was left to the discretion of the hospital systems. The hospitals expended significant effort in crisis planning and resource management and were able to keep surgery departments running at or near normal capacity.”
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