key: cord-0816599-klqv5dbf
authors: Pirracchio, Romain; Mavrothalassitis, Orestes; Mathis, Michael; Kheterpal, Sachin; Legrand, Matthieu
title: The response of US hospitals to elective surgical cases in the COVID-19 pandemic
date: 2020-10-19
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.10.013
sha: 553b36a1bfea569d50c0e89f7a276917449679cf
doc_id: 816599
cord_uid: klqv5dbf

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validation 4 . Between 1 January 2019 and 32 May 2020, all surgical cases at 33 health systems were totalled weekly to achieve maximum timing precision without influence by standard weekend reductions in case volume. Weekly case volumes were analysed via segmented regression and compared between 2019 and 2020.

We analysed 1,979,445 cases and observed a sharp decline in procedures during the week of March 16 th 2020 (Figure 1 ), as COVID-19 diagnoses began to rise nationally 5 . We observed a nadir in case volumes the week of April 6. During the week of April 6, we observed a 71% reduction compared to the same week in 2019. Between March 16 and May 31, the median per-week reduction in case volume relative to the same weeks in 2019 was 57% (interquartile range 39-67%)( Figure 1 ). This reduction primarily reflected elective cases (10,237 cases per week in 2020 vs 27,122 in 2019; 62% reduction, paired Wilcoxon rank sum test p<0.001) whereas the volume of emergent cases decreased to a lesser extent (1,248 vs 1,350; 8% reduction, p=0.024), as observed for other medical conditions 6 .

We also observed significant heterogeneity in case volume reductions across institutions, with perinstitution median weekly reductions ranging from 33% to 72% (intraclass correlation coefficient 0.53, 95% confidence interval 0.45-0.61, F-test p<0.001). The decrease in case volumes was followed by a rapid increase such that by May 31, surgical case volumes were within 20% of case volumes at the same time in 2019 ( Figure 1 ).

To summarize, an early rapid decrease in US surgical case volumes beginning mid-March 2020 was followed by a similarly rapid increase towards baseline beginning by mid-April while the pandemic was active and the numbers of COVID-19 cases was rising quickly. Case volume reductions varied significantly by institution. Important lessons can be learned from these observations. The global recommendations to cancel elective surgeries at the beginning of the pandemic regardless the local situations of COVID-19 cases and hospitalization should probably be more gradually implemented and adjusted based on local J o u r n a l P r e -p r o o f situations. The rapid increase in number of surgical procedures while the pandemic was very active certainly illustrates a perception of inappropriate adjustments of elective cases volume by many local situations. The need for more local adjustments is further illustrated by the homogenous timing of changes in surgical volumes across the country while the COVID-19 case surges were more temporally dispersed across the country.

Further analysis will be necessary to understand the specific factors which influenced the local and regional heterogeneity and the potential impact on patient outcomes to further inform public health response to future waves. We suggest a more locally and temporally adjusted response from US hospitals depending on COVID-19 hospitalizations trends to prevent avoidable cancellation of surgical cases which might unnecessarily impact patient prognosis and hospital financial security.

RP: Study design, statistical analysis, figure creation, manuscript review OM: Study design, data cleaning, manuscript review MM, SK: Study design, manuscript review ML: Study conception, study design, manuscript drafting

The authors have no competing interests to declare.

This work was supported by UCSF departmental funding to ML. 

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