Impact of COVID‐19 Restrictions on Demographics and Outcomes of Patients Undergoing Medically Necessary Non‐Emergent Surgeries During the Pandemic

Abstract

Background The COVID-19 pandemic has resulted in large-scale healthcare restrictions to control viral spread, reducing operating room censuses to include only medically necessary surgeries. The impact of restrictions on which patients undergo surgical procedures and their perioperative outcomes is less understood. Methods Adult patients who underwent medically necessary surgical procedures at our institution during a restricted operative period due to the COVID-19 pandemic (March 23-April 24, 2020) were compared to patients undergoing procedures during a similar time period in the pre-COVID-19 era (March 25-April 26, 2019). Cardinal matching and differences in means were utilized to analyze perioperative outcomes. Results 857 patients had surgery in 2019 (pre-COVID-19) and 212 patients had surgery in 2020 . The COVID-19 era cohort had a higher proportion of patients who were male (61.3% vs. 44.5%, P \ 0.0001), were White (83.5% vs. 68.7%, P \ 0.001), had private insurance (62.7% vs. 54.3%, p 0.05), were ASA classification 4 (10.9% vs. 3%, P \ 0.0001), and underwent oncologic procedures (69.3% vs. 42.7%, P \ 0.0001). Following 1:1 cardinal matching, COVID-19 era patients (N = 157) had a decreased likelihood of discharge to a nursing facility (risk difference-8.3, P \ 0.0001) and shorter median length of stay (risk difference-0.6, p 0.04) compared to pre-COVID-19 era patients. There was no difference between the two patient cohorts in overall morbidity and 30-day readmission.Conclusions COVID-19 restrictions on surgical operations were associated with a change in the racial and insurance demographics in patients undergoing medically necessary surgical procedures but were not associated with worse postoperative morbidity. Further study is necessary to better identify the causes for patient demographic differences.

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

“…In our study, we found that more patients had statutory insurance during the lockdown period. This is contrary to a study performed at the Hospital of the University of Pennsylvania, which found that a higher proportion of patients undergoing medically necessary surgeries during the pandemic had private insurance instead of statutory insurance [32] . The reasons may lie in the very different insurance systems.…”

Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT

“… 3 4 Medically necessary non-emergent surgeries were more likely to be performed on White patients with private insurance compared with any other group during the pandemic. 3 …”

“…During the COVID-19 pandemic, patients from under-represented racial groups also suffered worse outcomes for non-COVID-19-related conditions highlighting pre-existing disparities in healthcare access and differences in ability to socially distance at work and home 3 4. Medically necessary non-emergent surgeries were more likely to be performed on White patients with private insurance compared with any other group during the pandemic 3…”

Intersectionality and the Surgical Patient

“…Hospitals nationwide canceled or postponed nonessential operations during the height of the pandemic to minimize viral transmission and preserve medical resources. 1 Patient lives were upended by shifts to virtual schooling, closure of childcare facilities, and increasing unemployment rates. Additionally, there were concerns the pandemic will widen surgical disparities for populations who have historically faced difficulties in accessing and receiving surgical care.…”

“…The coronavirus pandemic has brought an explosion in surgical literature on the implications of social determinants of health and race/ethnicity on access to surgical care and clinical outcomes such as mortality. Hospitals nationwide canceled or postponed nonessential operations during the height of the pandemic to minimize viral transmission and preserve medical resources 1 . Patient lives were upended by shifts to virtual schooling, closure of childcare facilities, and increasing unemployment rates.…”