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Short-term Effects of Canceled Elective Procedures Due to COVID-19: Evidence From the Veterans Affairs Healthcare
Linda Diem Tran1,2, Liam Rose1,2, Tracy Urech3
1Health Economics Resource Center, Department of Veterans Affairs, Menlo Park, California.
Insights
The pause in elective surgeries due to COVID-19 did not increase emergency department visits or mortality. This suggests appropriate patient management during the pandemic, though long-term effects require further study.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Epidemiology
Background:
- The COVID-19 pandemic prompted a nationwide pause on elective surgical procedures in VA hospitals starting March 15, 2020.
- The impact of this disruption on patient outcomes, specifically emergency department (ED) utilization and mortality, was previously unknown.
Purpose of the Study:
- To investigate whether canceled or delayed elective surgeries due to COVID-19 led to increased ED utilization.
- To determine if these cancellations were associated with higher mortality rates post-procedure.
Main Methods:
- A retrospective cohort study utilized data from the VA Corporate Data Warehouse.
- Surgical procedures canceled in 2020 (n=3326) were matched with completed procedures from 2018 and 2019 (n=298,445) based on procedure type and patient characteristics.
- Outcome measures included 30- and 90-day ED visits and mortality rates.
Main Results:
- Patients whose elective surgeries were canceled due to COVID-19 showed no significant increase in ED visits at 30 or 90 days post-expected procedure date.
- Mortality rates at 30 and 90 days were also not significantly different between patients with canceled procedures and those with completed procedures in prior years.
Conclusions:
- The temporary halt of elective surgical cases during the COVID-19 pandemic was not linked to adverse short-term outcomes in VA hospitals.
- Findings suggest effective surgical case triage and management protocols were in place.
- Further research is needed to assess potential long-term effects of delayed elective procedures.
Objective:
To determine whether delayed or canceled elective procedures due to COVID-19 resulted in higher rates of ED utilization and/or increased mortality.
Summary Of Background Data:
On March 15, 2020, the VA issued a nationwide order to temporarily pause elective cases due to COVID-19. The effects of this disruption on patient outcomes are not yet known.
Methods:
This retrospective cohort study used data from the VA Corporate Data Warehouse. Surgical procedures canceled due to COVID-19 in 2020 (n = 3326) were matched to similar completed procedures in 2018 (n = 151,863) and 2019 (n = 146,582). Outcome measures included 30- and 90-day VA ED use and mortality in the period following the completed or canceled procedure. We used exact matching on surgical procedure category and nearest neighbor matching on patient characteristics, procedure year, and facility.
Results:
Patients with elective surgical procedures canceled due to COVID-19 were no more likely to have an ED visit in the 30- [Difference: -4.3% pts; 95% confidence interval (CI): -0.078, -0.007] and 90 days (-0.9% pts; 95% CI: -0.068, 0.05) following the expected case date. Patients with cancellations had no difference in 30- (Difference: 0.1% pts; 95% CI: -0.008, 0.01) and 90-day (Difference: -0.4% pts; 95% CI: -0.016, 0.009) mortality rates when compared to similar patients with similar procedures that were completed in previous years.
Conclusions:
The pause in elective surgical cases was not associated with short-term adverse outcomes in VA hospitals, suggesting appropriate surgical case triage and management. Further study will be essential to determine if the delayed cases were associated with longer-term effects.
