Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis
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Jashvant Poeran1, Haoyan Zhong2, Lauren Wilson2
1From the Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Suspending elective surgeries had a minor impact on intensive care unit (ICU) bed capacity in New York State. Medical and emergent admissions utilized more ICU resources than elective surgery patients.
Area of Science:
- Healthcare Management
- Public Health Policy
- Critical Care Medicine
Background:
- New York State suspended elective surgeries during the COVID-19 pandemic to increase intensive care unit (ICU) bed capacity.
- The actual impact of this suspension on ICU bed availability was not well understood.
Purpose of the Study:
- To analyze the utilization of ICU beds and mechanical ventilators in New York State.
- To determine the proportion of ICU resources used by patients admitted for elective surgery compared to other admission types.
Main Methods:
- Retrospective review of 5 years of New York State ICU data (2011-2015).
- Stratification of ICU utilization and mechanical ventilation by admission source (elective surgery, emergent/urgent/trauma surgery, medical) and region.
- Inclusion of all adult and pediatric ICU patients.
Main Results:
- ICU admissions represented 10.1% of all hospitalizations and remained stable from 2011-2015.
- Elective surgery patients accounted for 13.4% of ICU admissions and 6.4% of mechanical ventilation use.
- Emergent/urgent/trauma surgery (28.0%) and medical admissions (58.6%) constituted the majority of ICU utilization.
Conclusions:
- Elective surgery patients used a small fraction of ICU beds and mechanical ventilators.
- Suspending elective surgeries likely had a minimal effect on overall ICU capacity compared to emergent and medical admissions.
- Further research is needed to optimize ICU resource allocation during public health crises.
Background:
In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear.
Methods:
We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included.
Results:
Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State.
Conclusions:
Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.
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