Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.
Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.
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DOI：
10.1001/jamahealthforum.2021.4214
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Figueroa JF
中科院分区：
文献类型：
--
作者：
Tsai TC;Bryan AF;Rosenthal N;Zheng J;Orav EJ;Frakt AB;Figueroa JF
2019冠状病毒病大流行在多大程度上减少了获得手术护理的机会，少数种族和族裔群体更有可能减少获得手术护理的机会？在这项队列研究中，医院管理数据库中的767家美国医院的1300多万住院和门诊手术病例中，2020年的手术使用率比2019年下降了13%，其中最大的下降集中在择期手术。虽然黑人和西班牙裔患者的手术次数减少，但白色患者的手术次数减少最多。尽管2019冠状病毒病大流行期间卫生系统受到严重和持续的干扰，但少数种族和族裔群体获得外科护理的机会并未出现不成比例的减少。COVID-19大流行期间外科护理中断的程度尚未在国家层面上进行经验表征。描述COVID-19大流行期间手术紧急队列中手术护理的使用情况，并评估种族和民族差异。这是一项回顾性观察性研究，使用了Premier Healthcare数据库中767家医院的地理位置多样的所有付款人数据。手术分为4个手术紧急性队列（择期、非择期、急诊和创伤）。一个具有医院固定效应的广义线性回归模型评估了2020年与2019年相比每月医院内手术次数的相对减少。结局是总体手术次数的每月相对减少，以及手术紧急性队列和人种和种族之间的相对减少。样本包括13175087住院和门诊手术。与二零一九年相比，二零二零年的手术使用相对减少12. 6%。在所有手术队列中，最显著的减少发生在2020年春季。例如，选择性接触在3月开始下降，4月达到低谷，随后恢复，但从未恢复到大流行前的水平（3月：-26.8%; 95%CI，-29.6%至23.9%; 4月：-74.6%; 95%CI，-75.5%至73.5%; 12月：-13.3%; 95%CI，-16.6%至9.8%）。在所有手术紧急性队列中，白色患者的手术次数相对减少最多。如这项队列研究所示，COVID-19大流行对所有类别的紧急手术的外科护理造成了巨大干扰，尤其是择期手术。与白色患者相比，种族和少数民族患者的手术治疗中断较少。需要进一步的研究来探讨白色患者手术使用的减少是否是由于患者的自由裁量权，并记录手术护理的需求是否会反弹到基线水平。这项队列研究检查了COVID-19大流行期间手术紧急性队列的手术护理使用情况，并评估了护理中是否存在种族或民族差异。
To what extent did the COVID-19 pandemic reduce access to surgical care, and were racial and ethnic minority groups more likely to have reduced access to surgical care? In this cohort study of more than 13 million inpatient and outpatient surgical encounters in 767 US hospitals in a hospital administrative database, surgical use was 13% lower in 2020 compared with 2019, with the greatest decrease concentrated in elective surgical procedures. While Black and Hispanic patients experienced a reduction in surgical encounters, White patients experienced the greatest reduction in surgical encounters. Despite severe and persistent disruptions to health systems during the COVID-19 pandemic, racial and ethnic minority groups did not experience a disproportionate decrease in access to surgical care. The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level. To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities. This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019. Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity. The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: −26.8%; 95% CI, −29.6% to −23.9%; April: −74.6%; 95% CI, −75.5% to −73.5%; December: −13.3%; 95% CI, −16.6%, −9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters. As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels. This cohort study examines the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic and assesses whether there are racial or ethnic disparities in care.
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影响因子：
13.8
作者：
Rosenthal N;Cao Z;Gundrum J;Sianis J;Safo S
通讯作者：
Safo S
DOI：
10.1016/j.ajem.2020.11.029
发表时间：
2021-04
期刊：
The American journal of emergency medicine
影响因子：
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作者：
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作者：
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通讯作者：
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影响因子：
3.6
作者：
Rosen, AB;Tsai, JS;Downs, SM
通讯作者：
Downs, SM
影响因子：
16.9
作者：
Haider, Adil H.;Schneider, Eric B.;Freischlag, Julie A.
通讯作者：
Freischlag, Julie A.