ABSTRACT
Introduction: The COVID-19 pandemic has had widespread effects on the healthcare system. For trainees, one particular detriment has been the cancellation of elective operations, reducing clinical experience and procedural volumes. Measures instituted to combat the pandemic have resulted in decreased cancellation of elective cases to varying degrees. The aim of this study is to evaluate the ongoing effect of the pandemic on resident operative volume. Method(s): Operative case numbers of general surgical graduates in 2019, 2020, and 2021 were extracted from the Accreditation Council for Graduate Medical Education case logs. Data included mean total cases/graduate and means for individual case types. Data was considered by overall number of cases and cases performed as surgeon chief. Analysis of variance was employed to compare groups with p<0.05 considered significant. Result(s): Mean total major cases differed significantly among groups with reduced volume noted for 2020 graduates but no difference in volume between 2019 and 2021 graduates (1070.5+/-150 vs 1054.8+/-155 vs 1074.1+/-164, p=0.0041). This same pattern was noted for surgeon chief total cases (288.6+/-69 vs 264.4+/-67 vs 286.2+/-73, p<0.0001) as well as several major general surgery subcategories including cases involving the stomach, small intestine, large intestine, biliary system, among others. Conclusion(s): Despite continued reduction in and alteration of elective surgery practice, improved pandemic measures have allowed for increased surgical volume. This has translated to increased operative experience for graduating surgical trainees that are comparable to case numbers that preceded the pandemic. Ramifications for the 2020 graduating cohort as well subsequent cohorts require continued evaluation.
ABSTRACT
INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Given widespread disruptions to healthcare during the COVID-19 pandemic, the objective was to assess the national case logs of graduating Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows for effects on surgical volume. METHOD(S): The nationally aggregated Accreditation Council for Graduate Medical Education case logs were obtained for graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), for available academic years (AYs) 2018-2019, 2019-2020, and 2020- 2021. Standard deviation was derived from percentile data. Case volume differences for tracked index category averages were compared between AYs with one-way analysis of variance. RESULT(S): Graduating fellows logged an average of 517.4 (SD 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. Total surgical procedures were not statistically different between pre-COVID AY 2018- 2019 and COVID-affected AYs 2019-2020 and 2020-2021 for either specialty. For urology fellows, the only index case category with a statistically significant difference was a decrease in AY 2020-2021 compared to 2019-2020 in GI procedures (8.9 vs 4.2, p=0.04). Reclassification of mesh removal cases to genital procedures in 2020- 2021 resulted in a statistical decrease for both specialties of graft/mesh augmentation prolapse cases for that same AY. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSION(S): Compared to pre-pandemic case volumes, FPMRS urology and FPMRS OBGYN graduating fellow surgical volume remained stable. Both total surgical procedures and index case categories showed no statistically significant difference between pre-COVID and COVID-affected years. Despite nationwide disruptions in health care, FPMRS trainee case volumes remained consistent.
ABSTRACT
Background: Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods: The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results: The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions: The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.
Subject(s)
COVID-19 , Orthopedic Procedures , Orthopedics , Humans , COVID-19/epidemiology , Pandemics , Routinely Collected Health DataABSTRACT
Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1-2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.
Subject(s)
Arthroplasty, Replacement, Hip , COVID-19 , Humans , Pandemics , Retrospective Studies , RomaniaABSTRACT
BACKGROUND: The aim of this study is to investigate the impact that COVID-19 had on the pattern and trend of surgical volumes, urgency and reason for surgery during the first 6 months of the pandemic in sub-Saharan Africa. METHODS: This retrospective facility-based study involved collection of paediatric operation data from operating theatre records across 5 hospitals from 3 countries: Zimbabwe, Zambia and Nigeria over the first half of 2019 and 2020 for comparison. Data concerning diagnosis, procedure, anaesthesia, grade, speciality, NCEPOD classification and indication was collected. The respective dates of enactment of cancellation policies in each country were used to compare changes in weekly median surgical case volume before cancellation using the Wilcoxon Sign-Rank Test. RESULTS: A total of 1821 procedures were recorded over the study period. Surgical volumes experienced a precipitous drop overall from a median of 100 cases/week to 50 cases/week coinciding with cancellation of surgical electives. Median accumulated weekly procedures before COVID-related cancellation were significantly different from those after cancellation (p = 0.027). Emergency surgery fell by 23.3% while electives fell by 78,9% (P = 0.042). The most common primary indication for surgery was injury which experienced a 30.5% drop in number of procedures, only exceeded by congenital surgery which dropped 34.7%. CONCLUSIONS: The effects of surgical cancellations during the covid-19 pandemic are particularly devastating in African countries where the unmet need and surgical caseload are high. Continued cancellations that have since occurred will cause similar drops in surgical case volume that these health systems may not have the resilience to recover from. LEVEL OF EVIDENCE: Level II.
ABSTRACT
Background: The COVID-19 pandemic has largely affected spine care worldwide. At the beginning of the pandemic in Germany, surgical volume dropped markedly. Currently, it is unclear how surgical volume changed afterwards and especially during later pandemic waves. For this Registry study it was hypothesized that the COVID-19 pandemic in Germany is associated with a reduction of executed surgical spinal interventions, which was more prominent for specific spinal pathologies. Method(s): Surgical cases were selected from the German Spine Registry (DWG Register) during a 4-year period. Two groups were composed and compared. Patients enrolled prior to the start of the COVID-19 pandemic (before 01.01.2020) were included in group 'PRE-pandemic'. Patients admitted between 01.01.2020 and 31.12.2021 were selected for the group 'PANdemic'. We compared surgical volume over time and between groups. Subanalysis of specific pandemic waves and the impact on surgery foe specific spinal pathologies was studied as well. In order to optimize comparability, institutions that provided information during the entire study period were studied separately as well (adjusted analysis) Results: A total of 206841 patients have been identified. The prepandemic group included 89405 cases, whereas the PANDemic group had 117436 cases. A total of 142 institutions managed to include patients for this study (Fig.1a/b). As anticipated, monthly surgical volume did not differ between 2018 and 2019. However, an altered annual distribution pattern was seen in the pandemic years 2020 and 2021 Fig.2a/b). The additional adjusted analysis included 96 identical clinics. In parallel to pandemic waves, a drop in executed interventions was seen in the PANdemic group. Following the 1st pandemic wave, restoration of normal surgical volume took 3 months, whereas after later waves, normalization of surgical spine care occurred faster. Furthermore, following waves in 2021, a compensatory upsurge of surgical volume was seen. The most prominent reduction of surgical volume was seen in patients with degenerative diseases. In addition, a striking drop of performed interventions for critical categories such as infection and tumours occurred as well. Conclusion(s): The current study demonstrates that the COVID-19 pandemic is associated with decreased surgical load. However, restoration after pandemic waves occurs faster and more profound. Not only elective surgery rates dropped but also interventions for critical indications. During periods of peak COVID-19 incidences not only a decrease in performed elective surgeries was seen, but also the number of interventions for critical conditions dropped markedly. More protocols are required to optimize restoration of surgical volume after pandemic waves for different spine pathologies.
ABSTRACT
Resuming elective surgeries that were canceled during the COVID-19 pandemic necessitated a change to preprocedure patient preparation at a pediatric tertiary care center in middle Tennessee. We conducted a prospective, observational, mixed-methods study to determine the effectiveness of a preprocedure COVID-19 testing team to prevent COVID-19-related cancellations among pediatric patients receiving planned anesthesia. The intervention involved family member and patient education and a change in health record reporting to include COVID-19 test results. A team tasked with follow-up reviewed test results, consulted with families, and coordinated the administration of rapid tests if necessary. We compared preimplementation and postimplementation cancellation rates in four procedural areas and found no significant difference in the cancellation or rescheduling rates (P = .89, 95% confidence interval = -4.29 to 3.09). The team-based intervention was associated with the preservation of low procedural cancellation rates by mitigating barriers to preprocedural testing.
Subject(s)
COVID-19 , Child , Humans , COVID-19 Testing , Elective Surgical Procedures , Pandemics/prevention & control , Prospective StudiesABSTRACT
Introduction: With the relaxation of pandemic-related operative restrictions, there has been an increase in elective facial plastic surgical cases in comparison with 2018, prior to the COVID-19 pandemic. The objective of this study is to compare the surgical volume of pre-COVID-19 pandemic cosmetic facial plastic surgery (FPS) in 2018 with the postpandemic volume in 2021, in both a tertiary care academic practice and community practice. Method(s): This is a retrospective chart review of adult patients undergoing cosmetic FPS at an academic tertiary care center and community practice: Louisiana State University Health Shreveport (LSU) and Kenneth Sanders Facial Plastic Surgery in Louisiana, respectively. Information assessed included demographics, surgical date, and surgical procedure performed during the first 6 months of 2018 and 2021. Categorical variables were compared using 2-proportion z test and Pearson chi2 test. Odds ratio (OR) was used to calculate the likelihood of procedural year predicting subsequent FPS. Result(s): One hundred thirty-nine patients were identified: 58 (41.7%) patients in 2018 and 81 (58.3%) patients in 2021. The number of patients having FPS in the <30-year-old age group increased by 13.6% from 2018 to 2021 (P=.02). The number of septorhinoplasties increased by 20.5% from 2018 to 2021 (P=.01). Furthermore, the odds of one having a septorhinoplasty in 2021 increased 144% compared with 2018 (OR: 2.44 [95% CI, 1.19, 5.11]). The only cosmetic surgery to significantly decrease in volume during the postpandemic time period was rhytidectomy (OR: 0.33 [95% CI, 0.12, 0.82]). Conclusion(s): The COVID-19 pandemic has seen a significant rise in FPS in patients younger than 30 years and those electing to have septorhinoplasty. The etiology of this increase is not clear;however, possible explanations include the following: increased disposable income, "Zoom dysmorphia," and the ability for conspicuous recovery behind a mask.
ABSTRACT
Purpose : Pandemic era restrictions on non-essential travel, redistribution of healthcare resources, and nursing shortages have impacted the ability of ophthalmologists to deliver care. California had among the strictest 2020 restrictions during the pandemic with reallocation of non-essential surgical resources. This study assesses changes in surgical volume of common ophthalmic procedures in California since the COVID-pandemic. Methods : The California Health and Human Services Agency (Office of Statewide Health Planning & Development) maintains ambulatory and emergency room procedural databases. Common ophthalmic procedures and surgical volumes were extracted for 29 CPT codes from 2014-2020. Procedures with fewer than 100 cases were excluded. Results : Overall, ophthalmology surgical volume decreased by 19% from 2019 to 2020. Greatest declines were for anterior lamellar corneal transplant (39%) and pterygium with graft (38%). Simple cataract surgeries declined by 29% in 2020, compared to an average annual decline of 3% from 2014-2019. Volume increased only for two surgeries: aqueous shunt with graft (2%) and complex retinal detachment (0.2%). Temporal artery biopsies, historically stable with 0.2% average change from 2014-2019, declined by 28% in 2020. Retinal detachment repairs declined by 20% and 17% (with and without vitrectomy, respectively). In comparison, laparoscopic appendectomy only declined by 2% in 2020. Limitations of this study include role of population changes and changes in annual coding practices. Conclusions : COVID era declines were noted across almost all ophthalmic surgeries with steep drops in perceived non-urgent procedures such as pterygium and cataract. However, delays in cataracts and other conditions can result in increased disease burden and morbidity for patients. Uniquely, tube shunt procedures increased, perhaps due to progression of glaucoma from delayed routine care. For vision-preserving surgeries such as retinal detachment repair, lack of accessible care during the pandemic is especially concerning.
ABSTRACT
Purpose : Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada. Methods : Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results : In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. Conclusions : The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impact of the pandemic on the ophthalmic surgical backlog in Ontario.
ABSTRACT
Introduction: The COVID-19 pandemic has had a considerable and evolving impact on delivery of surgical care to patients. During the early stages of the pandemic, resource scarcity was experienced by many healthcare systems. This led to the implementation of a surgical moratorium on elective surgeries in New York State between the months of March through June 2020. Certain specialties, specifically those performing elective surgeries, experienced significant strain and transformation. Objective: This study aims to describe perioperative and intraoperative characteristics of patients undergoing hysterectomy for pelvic organ prolapse (POP) with and without concomitant urogynecology procedures between 2019-2021 at a multi-hospital healthcare system that experienced significantly strain and a subsequent moratorium on elective surgery during the first peak of the pandemic. Methods: This is a retrospective cohort analysis of all patients in a multi-hospital healthcare system in New York City who underwent hysterectomy for POP from August 19th, 2019 through August 11th, 2021. Cases were identified using procedural and diagnostic codes for hysterectomy and POP, respectively. Patients were separated into three cohorts based on dates corresponding to phases of the COVID-19 pandemic. The 'early peak' was defined from March through June 2020, coinciding with the New York State moratorium. The primary outcome was the stage of POP for patients undergoing surgery. Secondary outcomes included concomitant urogynecologic procedures, route of surgery, time from indication to procedure, length of inpatient stay, and utilization of pre-operative medical assessment/clearance (POMA). Results: A total of 253 cases were included: 106 (41.90%), 15 (5.93%), and 132 (52.17%) patients in the 'pre-pandemic','early peak pandemic', and 'stable pandemic' groups, respectively. Although not statistically significant, vaginal hysterectomy approach was performed less frequently during the 'early peak pandemic' and 'stable pandemic' cohorts (P = 0.0544). The 'early peak pandemic' cohort had significantly more stage IV POP compared to other cohorts (P = 0.0021). Rates of concomitant urogynecology procedures including slings, anterior or posterior repair, or apical repair did not differ between the cohorts. Further, cystoscopy was utilized intraoperatively more frequently in the 'stable pandemic' cohort (P = 0.0272). Time from surgical indication to operation was also significantly different with patients most frequently waiting at least 3 months in the 'early peak pandemic' group (P = 0.0132). Length of inpatient stay did not demonstrate a significant difference (P = 0.3982). The most frequent postoperative complication was transient voiding dysfunction, and this was observed more commonly in the 'stable pandemic' cohort (P = 0.0236), though overall no cases were complicated by persistent voiding dysfunction or urinary retention requiring surgical intervention in any group. Conclusions: In late spring 2020, when the moratorium was lifted, surgical volume returned to pre-peak numbers. However, time from booking to day of surgery remained significantly longer during and after the 'peak'. There was a statistically significant increase in patients with stage IV POP during the 'early peak' and 'stable' pandemic periods. There was a statistically significant increase in use of precautionary measures peri and intra-operatively during the 'peak' and 'stable pandemic' periods with significant increases in use of POMA performed outpatient by anesthesia and an increased utilization of intraoperative cystoscopy.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. OBJECTIVE: To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. METHODS: The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. RESULTS: During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR=0.62, 95% CI=0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. CONCLUSIONS: The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Prior to the COVID-19 pandemic, an estimated 4.8 billion individuals lacked access to basic surgical care worldwide, with near absence in many low-income/ middle-income countries (LMICs). Global health programs work to advance universal health coverage. The COVID-19 pandemic eliminated in-person surgical care and local training to LMICs provided by these programs. The objective of this study was to project a calculated impact of interrupted International Volunteers in Urology (IVUmed) global health surgical workshops since the start of the COVID-19 pandemic on patient care and training provided to partner LMIC sites. METHODS: Data from the 5 fiscal years (FY - April to March) prior to the COVID-19 pandemic was reviewed. This included metrics of number patients seen and surgical cases performed, local surgeons trained, countries visited, and estimated value of service provided as part of financial impact reporting. The last IVUmed workshop was March 5-15, 2020 and concludes the FY 2020. No surgical workshops were performed for FY 2021 and FY 2022 (through October 31, 2021). The projected FY loss of productivity for each metric was calculated by averaging the 5 FYs prior to FY 2021. The total loss since the COVID-19 pandemic was then calculated by the sum of the projected FY 2021 (this value) and that of FY 2022 thus far (7/12ths of this value). RESULTS: Averaging IVUmed surgical workshops over FY 2016-2020, 23 trips were taken each year to 13 countries. The average number of patients seen was 812, with an average of 564 surgical cases performed. The average number local surgeons involved in each workshop was 296. The FY average value of service was US$4,204,217.60. Projected losses for FY 2021 through October 31, 2021 (FY 2022 thus far) would be in the form of 36 trips to 21 countries. This has impacted 1,286 patients and meant the loss of 893 surgical cases. 469 local surgeons have been impacted by lost in-person training. The estimated value of service lost is US$6,656,677.86. CONCLUSIONS: COVID-19 has negatively impacted the already critically limited global surgical volume in LMICs. A simple calculation of lost surgical workshops thus far attempts to put a number on the impact this pandemic has had on the IVUmed program. This is the estimate of the impact of COVID-19 on only a single global health program, with the impact likely nearly immeasurable with the universal loss of global health services being provided during the pandemic. Such estimates can try to help global health programs prepare for the potential backlog of care and training that will be faced when workshops resume.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic limited global surgical missions. As a vaccine has been developed and deployed with low-/middle-income countries (LMICs) adjusting to a post-pandemic landscape, the question remains of how and when to restart surgical missions to these locations. This study reports the experience of International Volunteers in Urology (IVUmed) with identifying metrics of “readiness” for return to global health surgical workshops. METHODS: A survey was created and emailed in September 2021 to LMIC international partners where IVUmed has previously performed or is planning surgical workshops. The survey queried if international sites were ready for the return of surgical workshops, the timing of readiness, type workshop requested first, challenges faced including equipment limitations, and vaccination status. Results were tabulated. RESULTS: Of 30 emails sent, there were 12 responses. This represented 11 unique hospitals in 10 unique cities in 9 countries. The majority of respondents were from the continent of Africa (n=9) while the others were from Asia (n=2) and the Caribbean (n=1). Most respondents lived in countries where vaccines were available (75%) with all respondents stating they were vaccinated and are required to wear masks out in public. Most sites (66.7%) responded being ready for IVUmed workshops, with a start date of February 2022 (55.6%). 83% of respondents stated their hospital infrastructure could support a workshop, with 75% stating good access to personal protective equipment;58%, however, noted difficulty obtaining surgical supplies. Two respondents stating their hospitals continue to only perform emergent surgical cases. The most popular first workshops requested were pediatric urology and laparoscopy/endourology (30% each). Themes of the biggest challenge noted since the start of COVID-19 included 7 comments on performing operations, 4 about lack of supplies, and 2 about lost learning opportunities. CONCLUSIONS: It is unclear how and when to restart global health surgical mission programs since the start of the COVID-19 pandemic, which impacted the already critically limited global surgical volumes in LMICs. While LMIC partners queried report a high vaccination status, the vaccination status of the general population in surveyed countries has not been established. While this is an ongoing research project, important considerations for resumption of surgical missions must include careful assessment of timeliness, surgical and anesthetic capacity, facility resources, and safety. Direct communication with local sites is imperative.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The emergence of the COVID-19 pandemic resulted in elective surgical closures beginning in March 2020. In the immediate 6-months after COVID-19 began, there was a significant reduction in national resident operative experience. Our objective is to evaluate the impact of COVID-19 on urology resident surgical experience the year before and after COVID-19 using a national surgical case log registry. METHODS: Canadian national urology resident case log data (T-Res) was analyzed for the 2-year time period from March 15, 2019 - March 14, 2021 with respect to the 14 most commonly performed urological procedures. The 12-month time period prior to COVID-19 was compared to the 12-month time period after COVID-19. Data was analyzed from 11 residency programs with regular active users generating case logs over this time period. Total and specific case volumes per program and per resident user of the time period were analyzed. A paired Wilcoxon signed-rank test was used for comparison of mean cases pre- and post-COVID-19 with an alpha of 0.05 defined as significant. RESULTS: A total of 26,715 procedures were recorded over the 24-month period among 150 unique resident users in 11 training programs. In the 12-months prior to COVID-19, 11,906 procedures were logged while 14,809 procedures were logged in the 12-months after. Nationally, mean total case numbers per program (1082.4 vs. 1346.3;p=0.27) and per resident were not significantly reduced in the 12-months after COVID-19 when compared to 12-months prior (144.5 vs. 135.9;p=0.53). For specific surgeries by program, mean volumes per resident before and after COVID-19 were not significantly different including TURBT (18.5 vs. 19.4;p=0.66), TURP (11.3 vs. 11.7;p=0.72), PCNL (4.1 vs. 3.3;p=0.80), circumcision (6.9 vs. 5.9;p=0.25), hypospadias repair (0.9 vs. 0.6;p=0.39), hydrocelectomy (3.9 vs. 2.6;p=0.37), orchidopexy (4.2 vs. 4.1;p=0.99), ureteroscopy (18.6 vs. 21.3;p=0.53), stent insertion (17.7 vs. 16.7;p=0.77), radical prostatectomy (4.9 vs. 4.8;p=0.89), radical nephrectomy (3.6 vs. 4.0;p=0.75), partial nephrectomy (2.4 vs. 3.0;p=0.29), radical cystectomy (2.8 vs. 3.2;p=0.51), and cystolitholapaxy (3.1 vs. 2.5;p=0.48). While nationally overall case volumes were stable, 3/11 (27.3%) of programs continue to report a significant reduction in surgical volumes 1 year after COVID-19 even when adjusted for number of resident users. CONCLUSIONS: Based on this national case log sample resident operative experience has rebounded one year after COVID-19. However, 27.3% of programs still report significantly reduced case volumes per resident after COVID-19 and this may warrant further examination to ensure focal deficiencies in training don't arise.
ABSTRACT
The first foray into gynaecological minimal access surgery took place in 1936, when Swiss gynaecologist Boesch performed the first laparoscopic sterilisation. By 1988 advancements in surgical technology allowed Harry Reich to perform the first laparoscopic hysterectomy, and by 2022 the majority of gynaecological surgery can be carried out laparoscopically. Minimal access surgery reduces hospital stay and enhances post-operative recovery such that patients are often able to return to near normal function within one week. However, advancements in medical management of gynaecological conditions, the European Working Time Directive and the COVID-19 pandemic are just a few examples of how surgical volume has significantly decreased in recent times. The impact that this reduction in case load has had, and will continue to have, on the training of endoscopic surgeons in gynaecology must not be underestimated. It is well documented in the literature that improving training in laparoscopy results in better patient safety, thus it is imperative that we strive for structured minimal access training in gynaecology.
ABSTRACT
â¢There have been three distinct landmarks for the US surgical trainees leading to a decline in surgical volume and in open number of cases.â¢Global surgery experiences have been adopted to expose trainees to surgical problems not routinely seen in the Global North.â¢Global Surgery also exposes trainees to empathic and collaborative approaches.â¢Benefits of global surgery to compensate for the decline in volume, variety and open surgical cases need to be studied through an academic, ethical, and economic lens.â¢LMICs trainees could travel to HIC for research and clinical training in exchange for the skills and case volume that HIC trainees would obtain in LMICs.
ABSTRACT
BACKGROUND: Shifts in demand, capacity, and site of service have impacted total hip arthroplasty (THA) volumes and revenues over the 2019-2021 time period. Moving THA off the inpatient-only (IPO) list and the COVID-19 pandemic has caused a shift in delivery away from inpatient services and a decrease in demand. METHODS: Medicare claims data were surveyed for the latest period available (April 1, 2020 to September 2020) and compared with a similar period in 2019 prior to THA removal from the IPO list and before the COVID-19 pandemic. Length of stay (LOS), admission status, site of service, discharge status, cost to CMS (Centers of Medicaid and Medicare Services), and racial disparities were analyzed. RESULTS: From 2019 to 2020, changes in primary THA metrics occurred (overall change in total joint arthroplasty [THA plus total knee arthroplasty metrics]): CMS THA volume decreased from 78,691 to 65,360, -16% (-22%); THA performed as an outpatient increased from 0% to 51% (141%); THA performed as same-day discharge increased from 3% to 12%, 325% (221%); overall LOS decreased from 1.91 to 1.46, -23% (-11%); inpatient LOS increased from 1.92 to 2.05, 7% (16%); outpatient LOS increased from 0.92 to 0.93, 1% (-12%); discharge home increased from 82% to 91%, 12.8% (11%); and CMS spending decreased from $1,033 million to $751 million, -27% (-27%). CONCLUSION: Medicare payments, LOS, discharge to facilities, and volume declined from 2019 to 2020 and were accelerated by IPO list changes and COVID-19 issues. Same-day discharge and hospital outpatient department cases also increased. THA metrics were not affected by race.