Impact of the COVID-19 Pandemic on Inpatient and Outpatient Utilization of Bariatric Surgery

Abstract

Background During the COVID-19 pandemic, deferral of inpatient elective surgical procedures served as a primary mechanism to increase surge inpatient capacity. Given the benefit of bariatric surgery on treating obesity and associated comorbidities, decreased access to bariatric surgery may have long-term public health consequences. Understanding the extent of the disruption of the COVID-19 pandemic to bariatric surgery will help health systems plan for appropriate access. Materials and methods This is an observational cohort study using the PINC AI Healthcare Database from 1/1/2019–6/31/2021. A Poisson regression model with patient characteristics and hospital-fixed effects was used to assess the relative monthly within-hospital reduction in surgical encounters, variations by race and ethnicity, and shift from inpatient to outpatient procedures. A multivariate linear probability model was used to assess the change in 30-day readmissions from 2020 and 2021 compared to 2019. Results Among 309 hospitals, there were 46,539 bariatric procedures conducted in 2019 with a 14.8% reduction in volume to 39,641 procedures in 2020. There were 22,642 bariatric procedures observed from January to June of 2021. The most pronounced decrease in volume occurred in April with an 89.7% relative reduction from 2019. Black and Hispanic patients were more likely to receive bariatric surgery after the height of the pandemic compared to white patients. A clinically significant shift from inpatient to outpatient bariatric surgical procedures was not observed. Relative to 2019, there were no significant differences in bariatric surgical readmission rates. Conclusion During the pandemic there was a sizable decrease in bariatric surgical volume. There did not appear to be disparities in access to bariatric surgery for minority patients. We did not observe a meaningful shift toward outpatient bariatric surgical procedures. Post-pandemic, monitoring is needed to assess if hospitals have been able to meet the demand for bariatric surgical procedures. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09655-3.

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

“…In the recent past, several studies have quantified this reduction in the number of surgical procedures undertaken for total joint arthroplasty, 37 orthopedic knee procedures, 38 elective hernia repair, 39 and bariatric surgery. 40 Owing to the pandemic-related disruptions, we observed a sharp drop in the number of surgical admissions which required opioid use over the calendar year 2020. However, the trend of decreasing number of surgical admissions associated with opioid usage were identified over the calendar years preceding (2019) and following (2021) the onset of the pandemic.…”

Socioeconomic disparities in lumbar fusion rates were exacerbated during the COVID-19 pandemic

“…A national study on 767 hospitals assessing all payer types found that White patients experienced the greatest reduction in elective surgeries, compared to other racial groups, suggesting that the pandemic did not exacerbate racial disparities in elective surgical care [6] . Further studies in bariatric, cardiac, and orthopedic surgical subspecialties revealed that patient populations were more diverse (lessened racial and SES disparities) after the onset of the pandemic for some surgical procedures but less diverse (greater racial and SES disparities) for others [7] , [8] , [9] , [10] . Studies assessing academic general surgery departments, however, showed that male, White, and privately insured patients were more likely to undergo medically-necessary procedures during the pandemic [11] and that patients with higher SES (commercial or non-governmental insurance) were more likely to utilize both in-person and telemedicine visits during the pandemic [12] .…”