Pandemic Recovery: Persistent Disparities in Access to Elective Surgical Procedures.
Pandemic Recovery: Persistent Disparities in Access to Elective Surgical Procedures.
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DOI：
10.1097/sla.0000000000004848
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发表时间：
2023-01-01
影响因子：
9
通讯作者：
Wick EC
中科院分区：
文献类型：
--
作者：
Lin JA;Braun HJ;Schwab ME;Pierce L;Sosa JA;Wick EC
研究在COVID-19大流行的恢复阶段患者接受择期手术的潜在差异。疫情期间的择期手术受到严重限制。在恢复阶段恢复了手术治疗，但假设积压和社会变化会影响手术治疗。纳入了2019年3月16日至8月25日和2020年3月16日至8月25日期间具有电子健康记录程序（“程序请求”）的成年人。对未计划的要求手术进行逻辑回归。对从申请到计划或完成手术的等待时间进行线性回归。提出手术要求的患者人数由2019年的26，789人减少20. 8%至2020年的21，162人。年龄在36-50岁和>65岁的患者，那些说非英语语言的人，那些有医疗保险或没有保险的人，以及那些居住在100英里以外的人有不成比例的更大的下降。对于母语不是英语、西班牙语或广东话的患者，要求的程序显著增加了未安排的校正比值比（aOR）（aOR 1.60，95%置信区间[CI] 1.12-2.28）;未婚婚姻状况（aOR 1.21，95% CI 1.07-1.37）;无保险或自费（aOR 2.03，95% CI 1.53-2.70）。对于年龄在36-65岁之间的患者，等待时间明显更长;有Medi-Cal保险;来自收入较低的邮政编码;以及来自邮政编码>100英里以外。在大流行恢复阶段，患者接受择期手术的机会减少，差异基于患者年龄、语言、婚姻状况、保险、社会经济地位和与护理的距离。已经采取步骤解决可以改变的差距。疫情急性期及恢复期的手术量较二零一九年减少20%，产生大量积压。由于手术量在恢复阶段恢复，患者年龄，语言，婚姻状况，保险，社会经济地位和距离我们的机构不成比例地限制了获得手术护理。
To examine potential disparities in patient access to elective procedures during the recovery phase of the COVID-19 pandemic. Elective surgeries during the pandemic was limited acutely. Access to surgical care was restored in a recovery phase but backlogs and societal shifts are hypothesized to impact surgical access. Adults with electronic health record orders for procedures (“procedure requests”), from March 16 to August 25, 2019 and March 16 to August 25, 2020, were included. Logistic regression was performed for requested procedures that were not scheduled. Linear regression was performed for wait time from request to scheduled or completed procedure. The number of patients with procedure requests decreased 20.8%, from 26,789 in 2019 to 21,162 in 2020. Patients aged 36–50 and >65 years, those speaking non-English languages, those with Medicare or no insurance, and those living >100 miles away had disproportionately larger decreases. Requested procedures had significantly increased adjusted odds ratios (aORs) of not being scheduled for patients with primary languages other than English, Spanish, or Cantonese (aOR 1.60, 95% confidence interval [CI] 1.12–2.28); unpartnered marital status (aOR 1.21, 95% CI 1.07–1.37); uninsured or self-pay (aOR 2.03, 95% CI 1.53–2.70). Significantly longer wait times were seen for patients aged 36–65 years; with Medi-Cal insurance; from ZIP codes with lower incomes; and from ZIP codes >100 miles away. Patient access to elective surgeries decreased during the pandemic recovery phase with disparities based on patient age, language, marital status, insurance, socioeconomic status, and distance from care. Steps to address modifiable disparities have been taken. Surgical volume during the pandemic acute and recovery phases decreased 20% compared to 2019 generating a large backlog. As surgical volume was restored during the recovery phase, patient age, language, marital status, insurance, socioeconomic status, and distance from our institution disproportionately limited access to surgical care.