The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States

Amanda C Purdy; Brian R Smith; Samuel F Hohmann; Ninh T Nguyen

doi:10.1007/s00464-021-08477-z

The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States

Surg Endosc. 2022 Mar;36(3):1943-1949. doi: 10.1007/s00464-021-08477-z. Epub 2021 Apr 19.

Authors

Amanda C Purdy¹, Brian R Smith², Samuel F Hohmann^{3

4}, Ninh T Nguyen⁵

Affiliations

¹ Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Los Angeles, USA.
² Department of Surgery, Irvine Medical Center, University of California, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
³ Center for Advanced Analytics and Informatics, Vizient, Irving, USA.
⁴ Department of Health Systems Management, Rush University, Chicago, USA.
⁵ Department of Surgery, Irvine Medical Center, University of California, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA. ninhn@hs.uci.edu.

Abstract

Background: In March 2020, the Surgeon General recommended limiting elective procedures to prepare for the COVID-19 surge. We hypothesize a consequence of COVID-19 is reduced operative volume across the country. We aim to examine changes in volume of common gastrointestinal operations during COVID-19, including elective, urgent/emergent, and cancer operations. We also evaluate if hospitals with more COVID-19 admissions were most impacted.

Methods: The Vizient database was used to determine monthly operative volume from November 2019 to June 2020 for elective operations (hiatal hernia repairs, bariatric surgery), urgent operations (cholecystectomies, appendectomies, inguinal hernia repairs), and cancer operations (colectomies, gastrectomies, esophagectomies). COVID-19 admissions per hospital were also determined. November 2019-January 2020 was defined as "pre-COVID." The monthly reduction in volume from pre-COVID was calculated for each operation. The top quartile (25%) of hospitals with the most COVID admissions were also evaluated separately from hospitals with fewer COVID cases. Data were analyzed using analysis of variance.

Results: Data from 559 hospitals were analyzed. The volumes of all operations evaluated were significantly reduced during the pandemic except gastrectomies and esophagectomies for cancer. The greatest reduction in all operations was in April. In April, the volume of bariatric surgery reduced by 98% (P < 0.001), hiatal hernia repairs by 96% (P < 0.001), urgent cholecystectomies by 42% (P < 0.001), urgent inguinal hernia repairs by 40% (P < 0.001), urgent appendectomies by 24% (P < 0.001), and colectomies for cancer by 39% (P < 0.001). Hospitals with the most COVID-19 admissions had greater reductions in all operations than hospitals with fewer COVID cases.

Conclusions: The coronavirus pandemic led to a significant reduction in volume of all gastrointestinal operations evaluated except gastrectomies and esophagectomies. While elective, non-cancer operations were most affected, urgent and some cancer operations also declined significantly. As COVID-19 continues to surge, Americans may suffer continued limited access to surgical care and a significant operative backlog may be forthcoming.

Keywords: COVID-19; Coronavirus; Operative volume; Pandemic; Surgery.

MeSH terms

COVID-19*
Colectomy
Elective Surgical Procedures
Humans
Pandemics*
SARS-CoV-2
United States / epidemiology