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A Retrospective Analysis of Surgical Acuity & Procedure Volume Before & During the COVID-19 Pandemic
Xavier P Fowler1, Brianna Krafcik2, Ming Cai1
1Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
Introduction:
In March 2020, the American College of Surgeons recommended postponing elective procedures amid the COVID-19 pandemic. We used Medicare claims to analyze changes in surgical and interventional procedure volumes from 2016 to 2021.
Methods:
We studied 37 common surgical and interventional procedures using 5% Medicare claims files from January 1, 2016, through December 31, 2021. Procedures were classified according to American College of Surgeons guidelines as low, intermediate, or high acuity, and counts were analyzed per calendar year quarter (Q1-Q4), with stratification by sex and race/ethnicity.
Results:
We observed 1,840,577 procedures and identified two periods of marked decline. In Q2 2020, overall procedure counts decreased by 32.2%, with larger declines in low (41.1%) and intermediate (30.8%) acuity procedures. High acuity procedures declined the least (18.2%). Overall volumes increased afterward but never returned to baseline. Another marked decline occurred in Q4 2021, with all acuity levels having declined to a similar extent (40.1%, 44.2%, and 46.9% for low, intermediate, and high acuity, respectively). High and intermediate acuity procedures declined more in Q4 2021 than Q2 2020 (P = 0.002). Similar patterns were observed across sex and race/ethnicity strata.
Conclusions:
Two major procedural volume declines occurred between 2020 and 2022 during the COVID-19 pandemic in the United States. High acuity (life or limb threatening) procedures were least affected in the first decline (Q2 2020) but not spared in second decline (Q4 2021). Future efforts should prioritize preserving high-acuity access during times of stress.
Insights
Surgical procedure volumes significantly decreased during the COVID-19 pandemic, with a second major decline impacting all acuity levels. High-acuity procedures were initially less affected but later saw substantial reductions.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Epidemiology
Background:
- The COVID-19 pandemic prompted recommendations to postpone elective surgeries.
- Analyzing surgical procedure volumes is crucial for understanding healthcare system strain.
Purpose of the Study:
- To analyze changes in surgical and interventional procedure volumes in Medicare beneficiaries from 2016 to 2021.
- To identify trends in procedure declines during the COVID-19 pandemic.
Main Methods:
- Utilized 5% Medicare claims data for 37 common surgical and interventional procedures.
- Classified procedures by acuity (low, intermediate, high) and analyzed quarterly volume changes.
- Stratified analysis by sex and race/ethnicity.
Main Results:
- Observed two major declines in procedure volumes: Q2 2020 and Q4 2021.
- Q2 2020 saw a 32.2% overall decrease, with higher impacts on low and intermediate acuity procedures.
- Q4 2021 experienced a significant decline across all acuity levels, with high-acuity procedures declining more than in Q2 2020.
Conclusions:
- The COVID-19 pandemic caused two significant disruptions to surgical procedure volumes in the US.
- While high-acuity procedures were initially resilient, they were also affected by later declines.
- Maintaining access to high-acuity procedures during public health crises is essential.
