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COVID-19 Insights & Analytics Issue 5
Impact on Surgical Procedures

Sep 30, 2020

Overview

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The COVID-19 Insights & Analytics newsletter is designed to provide you with a summary to quantify national trends that may help in COVID-19 response planning. The included data, analytics and dashboards are generated utilizing BD HealthSight™ Infection Advisor Analytics and are derived from electronic patient data from 338 participating U.S. hospitals initiated on March 1, 2020 through August 9, 2020 unless otherwise indicated.

Introduction

COVID-19 has had a significant impact on surgical procedures. Both in the early stage of the pandemic in late March and through the second wave in the South/Southwest. We will examine the surgical procedure data from a subset of 28 hospitals.

Executive Summary

  • During the initial wave of the COVID-19 pandemic, surgical procedures declined more (-57%) than inpatient admission (-35%) but then returned to normal pre-pandemic rates quicker than admission before being disrupted again with the second wave of COVID-19.
  • The second wave of the COVID-19 pandemic has reduced surgical procedure substantially less (-22% through Sept. 9) than the initial wave (-57%).
  • Contrasting surgical procedures conducted in an inpatient or outpatient setting, outpatient procedures were more greatly impacted by the pandemic with a sharp decline (-70%) during the initial wave of COVID-19 vs inpatient procedures (-30%).

Figure 1: Total Surgical Procedures & Inpatient Admissions (January 9 – August 9, 2020)

Figure 1 is of the 7-day average rate indexed to the average daily rate for January 15 to March 15 (pre-COVID-19 benchmark) for total surgical procedures & daily admissions

Figure 2: Newly reported cases in U.S. (Source: NY Times COVID-19 Tracker)

Commentary for Figure 1 and 2

  • In mid-March most states initiated a hold on elective procedures. This dropped the surgical procedure rate to 43% of the pre-COVID-19 baseline rate as of April 6.
  • Inpatient admissions likewise dropped simultaneously but with less total change, reaching a nadir at ~65% of pre-COVID-19 baseline rates.
  • Surgical procedures rebounded from April 6 back to the pre-COVID baseline rate by June 2 subsequent to states easing their restrictions in April and May.
  • The surgery rate began falling again in late June delineated by the July 4th holiday week (holiday weeks normally reduce procedure rates) and corresponds temporally with a second wave of COVID-19 positives seen across the south-east & south-west. As of September 9 (our latest reporting date) it is not clear if procedures are continuing to decline or if they are starting to rebound again.
  • The decline in procedures in the second wave (-22% through Sept. 9) is substantially less than the decline in the first wave (-57%). This may be due to different motivations for a purposeful decrease in surgeries when feasible: 1) the first wave decline was likely driven by state restrictions across the country bracing for the overall threat of a new pandemic: 2) the second wave decline was primarily only in the states seeing an increase in COVID-19 cases , and perhaps focused on conservation of beds to treat COVID-19 positive patients.
  • A potential third wave in the fall/winter may have a greater impact on surgical procedures (than the 2nd wave) as both influenza and COVID-19 will be active and presumably have an additive effect on bed capacity.
  • There appears to be a spike in surgical procedures in early March, potentially from an “acceleration” of procedures in anticipation of planned elective procedure restrictions.

Figure Figure 3: Inpatient & Outpatient Surgical Procedures (January 9 – August 9, 2020)

Figure 3 is of the 7-day average rate indexed to the average daily rate for January 15 to March 15 (pre-COVID-19 benchmark) for Inpatient & Outpatient procedures

Commentary for Figure 3

  • Outpatient procedures are non-acute or elective in nature, and therefore the ability to delay those procedures are more pronounced. Not surprisingly, outpatient procedures led the initial decline falling to 30% of baseline rate by early April. Inpatient procedures—presumably of higher clinical acuity-- fell much less nadiring at 70% of baseline run rate due to a heavier weight of emergent & urgent procedures.
  • Inpatient procedures were able to rebound to baseline and maintain a high rate in June before the July 4th holiday; a second surge of COVID-19 has a temporal correlation with subsequent decreases again in inpatient procedures.
  • The increase in surgeries early March—just before the COVID-19 pandemic surge-- was driven by Inpatient procedures. It also corresponds temporally with a decrease in outpatient procedures. Resource management may have been a goal, possibly to free up resources for the more urgent inpatient procedures and in preparation of COVID-19 patients. As an example, prior experience in Italy reported more need for ICUs during high COVID-19 activity (cite: https://www.thelocal.it/20200904/italy-reports-new-post-lockdown-high-of-1733-cases-as-number-in-intensive-care-rises)

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