Causation Not Correlation: Simple Mediation Analysis of Amputation Costs.

Area of Science:

• Health Economics
• Epidemiology
• Surgical Outcomes

Background:

• The COVID-19 pandemic disrupted healthcare delivery and hospital finances.
• Understanding its impact on surgical costs is crucial for healthcare system resilience.

Purpose of the Study:

• To analyze the pandemic's effect on costs for nonelective major lower extremity amputations (LEA).
• To identify mediating factors influencing these LEA costs during the pandemic.

Main Methods:

• Utilized Florida healthcare administrative data (2019-2021) for nonelective LEA patients.
• Compared costs across pre-COVID, COVID-heavy, and COVID-light periods.
• Employed mediation analysis to assess patient and hospital factors impacting cost.

Main Results:

• COVID-19 timeframes showed significant cost increases in total, hospital, ICU, and operating room expenses compared to pre-COVID.
• Acute kidney injury, sepsis, and electrolyte/acid-base disorders were identified as potential cost influencers during COVID periods.
• Sensitivity analysis indicated potential unmeasured confounding factors.

Conclusions:

• The COVID-19 pandemic substantially increased costs for nonelective major LEAs.
• Mediation analysis did not pinpoint specific patient-level mediators, suggesting systemic issues like supply chain disruptions and staffing shortages.
• The findings underscore the need for robust healthcare systems capable of managing crises and mitigating inequities.