Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic.
Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic.
复制标题
DOI：
10.1001/jamanetworkopen.2021.38038
复制
发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Wren SM
中科院分区：
文献类型：
--
作者：
Mattingly AS;Rose L;Eddington HS;Trickey AW;Cullen MR;Morris AM;Wren SM
这项队列研究比较了与COVID-19相关的择期手术关闭后以及COVID-19感染率高峰期间的手术量与大流行前的手术量。两次单独的COVID-19危机，一次是在最初关闭期间的政策驱动，另一次是在感染负担最高期间发生的，是否与美国外科卫生系统的外科手术量变化有关？在这项对2019年1月1日至2021年1月30日超过1300万例美国外科手术的队列研究中，在2020年3月建议取消择期外科手术后，总外科手术量立即减少了48.0%。除耳鼻喉科外，所有外科专科的手术量均恢复至2019年的水平，这一水平在秋季和冬季的COVID-19高峰期保持不变。这些发现表明，卫生系统学会了适应并能够自我调节，在COVID-19患者数量最大的高峰期间维持手术量。COVID-19大流行影响了医疗护理的各个方面，包括手术治疗。关键是要了解政府政策和感染负担与美国各地的手术通路的关联。描述政府建议关闭后美国外科手术量的变化以及随后COVID-19患者量的峰值激增。这项回顾性队列研究是使用来自全国性医疗保健技术交换中心的行政索赔进行的。使用了Change Healthcare医疗保健机构网络中美国49个州接受外科手术的儿科和成人患者的索赔。与二零一九年相比，二零二零年最初COVID-19相关停工期间的手术量以及随后的秋季和冬季感染激增。分析了2020年11月至2021年7月的数据。2020年政策，以减少择期手术程序和COVID-19患者的发病率。通过泊松回归估计发病率比（IRR），将初始关闭（2020年3月15日至5月2日）和随后的COVID-19激增（2020年10月22日至2021年1月31日）期间的总手术计数与相应的2019年日期进行比较。按照11个主要手术类别、25个子类别和12个示例性手术程序（沿着一系列择期至急诊适应症）对外科手术进行了分析。从2019年1月1日至2021年1月30日，根据3498个现行手术术语（CPT）代码，共识别出13108567例外科手术。这包括2019年的6 651 921例手术（妇女3 516 569例[52.9%];儿童613 192例[9.2%];年龄≥65岁的患者中有1 987 397例手术[29.9%]），2020年有5 973 573例手术（女性中3 156 240例手术[52.8%];儿童中482 637例手术[8.1%];年龄≥65岁患者中1 806 074例手术[30.2%]）。初始关闭期及其2019年同期（即流行病学第12-18周）的手术总数从2019年的905444例手术减少到2020年的458469例手术，IRR为0.52（95%CI，0.44 - 0.60; P < .001），减少了48.0%。与二零一九年的相应周数相比，所有主要类别的外科手术量均有所减少。在最初的关闭期间，耳鼻喉科（ENT）手术（IRR，0.30; 95% CI，0.13至0.46; P <0.001）和白内障手术（IRR，0.11; 95% CI，-0.11至0.32; P = 0.03）在主要类别中下降最多。器官移植和剖腹产与2019年的基线没有差异。在最初的关闭之后，在随后的COVID-19激增期间，外科手术量反弹至2019年的水平（IRR，0.97; 95%CI，0.95至1.00; P = 0.10），但耳鼻喉科手术除外（IRR，0.70; 95%CI，0.65至0.75; P <0.001）。在最初关闭期间，COVID-19患者的状态量与外科手术量之间存在相关性（r =-0.00025; 95%CI，-0.0042至-0.0009; P = .003），但在COVID-19激增期间没有相关性（r =-0.00034; 95%CI，-0.0075至0.00007; P = 0.11）。这项研究发现，2020年3月至4月的最初停工期与手术量减少至基线率的近一半有关。重新开放后，外科手术率回升至2019年的水平，并在秋冬季COVID-19患者负担高峰期保持这一趋势;这些发现表明，经过初步适应，卫生系统似乎能够自我调节并以大流行前的能力运作。
This cohort study compares surgical procedure volume after the COVID-19–related shutdown of elective procedures and during the period of peak COVID-19 infection rates with prepandemic procedure volume. Were 2 separate COVID-19 crises, one policy driven during the initial shutdown and the other occurring during the highest burden of infections, associated with changes in surgical procedure volume in the US surgical health system? In this cohort study of more than 13 million US surgical procedures from January 1, 2019, through January 30, 2021, there was a 48.0% decrease in total surgical procedure volume immediately after the March 2020 recommendation to cancel elective surgical procedures. Surgical volume returned to 2019 rates in all surgical specialties except otolaryngology, a rate maintained during the COVID-19 peak surge in fall and winter. These findings suggest that health systems learned to adapt and were able to self-regulate, maintaining surgical procedure volume during the largest peak in volume of patients with COVID-19. The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19–related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures among patients aged ≥65 years [30.2%]). The total number of procedures during the initial shutdown period and its corresponding period in 2019 (ie, epidemiological weeks 12-18) decreased from 905 444 procedures in 2019 to 458 469 procedures in 2020, for an IRR of 0.52 (95% CI, 0.44 to 0.60; P < .001) with a decrease of 48.0%. There was a decrease in surgical procedure volume across all major categories compared with corresponding weeks in 2019. During the initial shutdown, otolaryngology (ENT) procedures (IRR, 0.30; 95% CI, 0.13 to 0.46; P < .001) and cataract procedures (IRR, 0.11; 95% CI, −0.11 to 0.32; P = .03) decreased the most among major categories. Organ transplants and cesarean deliveries did not differ from the 2019 baseline. After the initial shutdown, during the ensuing COVID-19 surge, surgical procedure volumes rebounded to 2019 levels (IRR, 0.97; 95% CI, 0.95 to 1.00; P = .10) except for ENT procedures (IRR, 0.70; 95% CI, 0.65 to 0.75; P < .001). There was a correlation between state volumes of patients with COVID-19 and surgical procedure volume during the initial shutdown (r = −0.00025; 95% CI, −0.0042 to −0.0009; P = .003), but there was no correlation during the COVID-19 surge (r = −0.00034; 95% CI, −0.0075 to 0.00007; P = .11). This study found that the initial shutdown period in March through April 2020, was associated with a decrease in surgical procedure volume to nearly half of baseline rates. After the reopening, the rate of surgical procedures rebounded to 2019 levels, and this trend was maintained throughout the peak burden of patients with COVID-19 in fall and winter; these findings suggest that after initial adaptation, health systems appeared to be able to self-regulate and function at prepandemic capacity.
登录
查看更多内容
影响因子：
56.9
作者：
Gonzalez-Reiche, Ana S.;Hernandez, Matthew M.;van Bakel, Harm
通讯作者：
van Bakel, Harm
影响因子：
2.5
作者：
Chang, Edward I.;Liu, Jesse Jun
通讯作者：
Liu, Jesse Jun
DOI：
10.1097/j.jcrs.0000000000000337
发表时间：
2020-11-01
影响因子：
2.8
作者：
Aggarwal, Shruti;Jain, Punya;Jain, Amit
通讯作者：
Jain, Amit
DOI：
10.1002/hed.26260
发表时间：
2020-05-16
影响因子：
2.9
作者：
Bowman, Ryan;Crosby, Dana L.;Sharma, Arun
通讯作者：
Sharma, Arun
影响因子：
13.8
作者：
Whaley CM;Pera MF;Cantor J;Chang J;Velasco J;Hagg HK;Sood N;Bravata DM
通讯作者：
Bravata DM