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Association Between the COVID-19 Pandemic and Disparities in Access to Major Surgery in the US.
Glance, Laurent G; Chandrasekar, Eeshwar K; Shippey, Ernie; Stone, Patricia W; Dutton, Richard; McCormick, Patrick J; Shang, Jingjing; Lustik, Stewart J; Wu, Isaac Y; Eaton, Michael P; Dick, Andrew W.
  • Glance LG; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York.
  • Chandrasekar EK; Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York.
  • Shippey E; RAND Health, RAND, Boston, Massachusetts.
  • Stone PW; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York.
  • Dutton R; Vizient Center for Advanced Analytics, Chicago, Illinois.
  • McCormick PJ; Columbia School of Nursing, Center for Health Policy, New York, New York.
  • Shang J; US Anesthesia Partners, Dallas, Texas.
  • Lustik SJ; Memorial Sloan-Kettering Cancer Center, New York, New York.
  • Wu IY; Columbia School of Nursing, Center for Health Policy, New York, New York.
  • Eaton MP; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York.
  • Dick AW; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York.
JAMA Netw Open ; 5(5): e2213527, 2022 05 02.
Article in English | MEDLINE | ID: covidwho-1858510
ABSTRACT
Importance Racial minority groups account for 70% of excess deaths not related to COVID-19. Understanding the association of the Centers for Medicare & Medicaid Services' (CMS's) moratorium delaying nonessential operations with racial disparities will help shape future pandemic responses.

Objective:

To evaluate the association of the CMS's moratorium on elective operations during the first wave of the COVID-19 pandemic among Black individuals, Asian individuals, and individuals of other races compared with White individuals. Design, Setting, and

Participants:

This cross-sectional study assessed a 719-hospital retrospective cohort of 3 470 905 adult inpatient hospitalizations for major surgery between January 1, 2018, and October 31, 2020. Exposure The first wave of COVID-19 infections between March 1, 2020, and May 31, 2020. Main Outcomes and

Measures:

The main outcome was the association between changes in monthly elective surgical case volumes and the first wave of COVID-19 infections as a function of patient race, evaluated using negative binomial regression analysis.

Results:

Among 3 470 905 adults (1 823 816 female [52.5%]) with inpatient hospitalizations for major surgery, 70 752 (2.0%) were Asian, 453 428 (13.1%) were Black, 2 696 929 (77.7%) were White, and 249 796 (7.2%) were individuals of other races. The number of monthly elective cases during the first wave was 49% (incident rate ratio [IRR], 0.49; 95% CI, 0.486-0.492; P < .001) compared with the baseline period. The relative reduction in unadjusted elective surgery cases for Black (unadjusted IRR, 0.99; 95% CI, 0.97-1.01; P = .36), Asian (unadjusted IRR, 1.08; 95% CI, 1.03-1.14; P = .001), and other race individuals (unadjusted IRR, 0.97; 95% CI, 0.95-1.00; P = .05) during the surge period compared with the baseline period was very close to the change in cases for White individuals. After adjustment for age, sex, comorbidities, and surgical procedure, there was still no evidence that the first wave of the pandemic was associated with disparities in access to elective surgery. Conclusions and Relevance In this cross-sectional study, the CMS's moratorium on nonessential operations was associated with a 51% reduction in elective operations. It was not associated with greater reductions in operations for racial minority individuals than for White individuals. This evidence suggests that the early response to the pandemic did not increase disparities in access to surgical care.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2022 Document Type: Article