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Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.
Tsai, Thomas C; Bryan, Ava Ferguson; Rosenthal, Ning; Zheng, Jie; Orav, E John; Frakt, Austin B; Figueroa, Jose F.
  • Tsai TC; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
  • Bryan AF; Center for Surgery and Public Health, Boston, Massachusetts.
  • Rosenthal N; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Zheng J; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
  • Orav EJ; Center for Surgery and Public Health, Boston, Massachusetts.
  • Frakt AB; Department of Surgery, The University of Chicago, Chicago, Illinois.
  • Figueroa JF; Premier Applied Sciences, Premier, Inc, Charlotte, North Carolina.
JAMA Health Forum ; 2(12): e214214, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1598802
ABSTRACT
Importance The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level.

Objective:

To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities. Design Setting and

Participants:

This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019. Main Outcomes and

Measures:

Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity.

Results:

The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March -26.8%; 95% CI, -29.6% to -23.9%; April -74.6%; 95% CI, -75.5% to -73.5%; December -13.3%; 95% CI, -16.6%, -9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters. Conclusions and Relevance As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Randomized controlled trials Language: English Journal: JAMA Health Forum Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Randomized controlled trials Language: English Journal: JAMA Health Forum Year: 2021 Document Type: Article