Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19 Pandemic and Postvaccination Recovery Period

Ghoshal, Soham; Rigney, Grant; Cheng, Debby; Brumit, Ryan; Gee, Michael S.; Hodin, Richard A.; Lillemoe, Keith D.; Levine, Wilton C.; Succi, Marc D.

doi:10.1001/jamanetworkopen.2022.27443

Cited by 39 publications

(29 citation statements)

References 22 publications

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“…Although the impact was largest during the COVID‐19 peak in mid‐2020, the provision of health care has not fully rebounded. For example, surgical oncology procedures at Massachusetts General Hospital were 72% of 2019 levels during the last one half of 2020 and were only 84% in 2021, the lowest recovery of any surgical specialty 1 . Delays in diagnosis and treatment may lead to an uptick in advanced‐stage disease and mortality 2 .…”

Section: Introductionmentioning

confidence: 99%

“…For example, surgical oncology procedures at Massachusetts General Hospital were 72% of 2019 levels during the last one half of 2020 and were only 84% in 2021, the lowest recovery of any surgical specialty. 1 Delays in diagnosis and treatment may lead to an uptick in advanced-stage disease and mortality. 2 These and other secondary consequences of the pandemic will occur gradually over time and will require many years to quantify at the population level because of the 2-year to 3-year lag in population-based cancer incidence and mortality data.…”

Section: Introductionmentioning

confidence: 99%

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Cancer statistics, 2023

Siegel

Miller

Wagle

et al. 2023

CA A Cancer J Clinicians

8,605

4,024

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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus‐associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cancer statistics, 2023

Siegel

Miller

Wagle

et al. 2023

CA A Cancer J Clinicians

8,605

4,024

View full text Add to dashboard Cite

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“…This could reflect a general stabilization in blood use in the broader healthcare system, with a continued trend toward less‐invasive surgeries but a nadir in the effect of increased adoption of patient blood management programs in non‐surgical clinical settings. Furthermore, the slightly more pronounced decrease in transfusions in surgery settings in 2021 compared to prior years could also reflect a continued impact the COVID‐19 pandemic had on surgery cancelations, as the surgical volume had not fully rebounded to pre‐pandemic levels by the beginning of 2021 18 . Additionally, unlike NBCUS results from 2017 and 2019, in 2021 there was less variability seen in differences in RBC use by hospital size.…”

Section: Discussionmentioning

confidence: 99%

Continued stabilization of blood collections and transfusions in the United States: Findings from the 2021 National Blood Collection and Utilization Survey

et al. 2023

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BackgroundNational Blood Collection and Utilization Surveys (NBCUS) have reported decreases in U.S. blood collections and transfusions since 2008. The declines began to stabilize in 2015–2017, with a subsequent increase in transfusions in 2019. Data from the 2021 NBCUS were analyzed to understand the current dynamics of blood collection and use in the United States.MethodsIn March 2022, all community‐based (53) and hospital‐based (83) blood collection centers, a randomly selected 40% of transfusing hospitals performing 100–999 annual inpatient surgeries, and all transfusing hospitals performing ≥1000 annual inpatient surgeries were sent a 2021 NBCUS survey to ascertain blood collection and transfusion data. Responses were compiled, and national estimates were calculated for the number of units of blood and blood components collected, distributed, transfused, and outdated in 2021. Weighting and imputation were applied to account for non‐responses and missing data, respectively.ResultsSurvey response rates were 92.5% (49/53) for community‐based blood centers, 74.7% (62/83) for hospital‐based blood centers, and 76.3% (2102/2754) for transfusing hospitals. Overall, 11,784,000 (95% confidence interval [CI], 11,392,000–12,177,000) whole blood and apheresis red blood cell (RBC) units were collected in 2021, a 1.7% increase from 2019; 10,764,000 (95% CI, 10,357,000–11,171,000) whole blood‐derived and apheresis RBC units were transfused, a 0.8% decrease. Total platelet units distributed increased by 0.8%; platelet units transfused decreased by 3.0%; plasma units distributed increased by 16.2%; and plasma units transfused increased by 1.4%.DiscussionThe 2021 NBCUS findings demonstrate a stabilization in U.S. blood collections and transfusions, suggesting a plateau has been reached for both.

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“…A retrospective time-series analysis of all surgical procedures conducted at a similarly sized tertiary care center in America found that urologic surgeries have only returned to 85% of pre-pandemic levels. 19 Deferral of surgical treatment is associated with significant risks ranging from deterioration in mental health and quality of life, to disease progression and increased rates of mortality. 20 Addressing backlogs is therefore crucial for minimizing patient morbidity and improving health outcomes.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

Comparative evaluation of 90-day patient outcomes and healthcare encounters following extended day surgery urethroplasty

McAllister

Rourke

Hoy

2023

CUAJ

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Introduction: Most centers have shifted to an extended day surgery (XDS) model for urethroplasty. Our study characterizes outcomes and unplanned healthcare encounters of patients undergoing XDS urethroplasty compared to case-matched inpatient controls. Methods: We conducted a retrospective, two-surgeon, single-center study of patients undergoing XDS urethroplasty (discharge <24 hrs) from November 2020 to November 2021. Patients were case-control matched based on age, stricture length, location, and etiology to patients who had previously undergone inpatient urethroplasty. Data was analyzed using descriptive and univariable statistics. Multivariable analysis by Cox proportional hazard regression was used to identify associations with postoperative complications. Results: Ninety patients (mean age=53.8 years) underwent XDS urethroplasty during the study period. Mean stricture length was 4.4 cm standard deviation [SD] 2.4). Rates of postoperative complications were similar between XDS (17%, n=15) and admitted patients (21%, n=19), and XDS was not associated with increased risk on univariable analysis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.31–1.3, p=0.36). When stratifying by location, penile stricture (OR 4.21, 95% CI 1.3–13.8, p=0.02), and lichen sclerosus (OR 2.91, 95% CI 0.79–9.9, p=0.08) were associated with increased risk of postoperative complication. On multivariable analysis, only penile stricture was identified as significant (OR 4.78, 95% CI 1.2–19.4, p=0.03). Forty-eight percent (n=43) of patients had unplanned healthcare encounters postoperatively, with similar numbers of phone calls (n=37) and emergency department visits (n=36) between groups. Conclusions: Our study shows that XDS urethroplasty is not associated with increased rates of complications relative to inpatient admission. This data supports using an XDS pathway for resource-efficient treatment of urethral strictures in a universal healthcare setting.

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Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19 Pandemic and Postvaccination Recovery Period

Cited by 39 publications

References 22 publications

Cancer statistics, 2023

Cancer statistics, 2023

Continued stabilization of blood collections and transfusions in the United States: Findings from the 2021 National Blood Collection and Utilization Survey

Comparative evaluation of 90-day patient outcomes and healthcare encounters following extended day surgery urethroplasty

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