COVID-19 Insights & Analytics Issue 5

Impact on Surgical Procedures

Sep 30, 2020

Hello! Was this newsletter forwarded to you? Sign up here.

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.

The data presented represents a national view of COVID trends. For additional information or to discuss how BD HealthSight™ Infection Advisor and/or other BD analytic tools could be utilized within your own hospital system click the button below.

Learn More

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)

true

COVID-19 Insights & Analytics Issue 5

Introduction

Commentary for Figure 1 and 2

Commentary for Figure 3

Subscribe and share your feedback on the analysis and ideas for future topics