Outpatient surgery trends during before and after the onset of the COVID-19 pandemic

1. Rates of outpatient surgery for several general surgery procedures were increased during the onset of the COVID-19 pandemic.

Evidence Rating Level: 2 (Good)

During the COVID-19 pandemic, guidelines from the American College of Surgeons (ACS) recommended increasing surgical load performed in an outpatient setting, to minimize risk of nosocomial infection for surgical patients, and to increase the number of beds available for COVID-19 patients. Several procedures have previously been shown to be feasible and safe in outpatient settings, with same-day discharge associated with reductions in infection rates and cost, as well as improved patient satisfaction. This retrospective study aimed to trend the rates of outpatient general surgery procedures from 2016 to 2020, to encompass the start of the pandemic. This study included hospitals in the USA partaking in the ACS National Surgical Quality Improvement Program, and trended the 16 common general surgery procedures, including breast surgery, endocrine surgeries, and minimally invasive (MIS) hernia repairs, gastric surgery, cholecystectomy, and colectomy for cancer. The evaluated outcome was the odds of outpatient surgery for each year of the study. In total, there were 988,436 patients studied, with 823,746 before the pandemic and 164,690 after. The study found that from 2016-2020, 4 procedures had clinically significant (≥10%) increases, including mastectomy for breast cancer (9.2% to 28.6%), thyroid lobectomy (43.2% to 57.9%), MIS ventral hernia repair (58.8% to 69.4%), and parathyroidectomy (51.8% to 61.8%). These trends were also assessed between 2019-2020 to capture data before and after the start of the pandemic, with 8 procedures having significant differences (p < 0.001) in outpatient surgery rates, including: Mastectomy (odds ratio 2.44, 95% CI 2.28-2.61), MIS adrenalectomy (OR 1.96, 95% CI 1.37-2.81), thyroid lobectomy (OR 1.43, 95% CI 1.32-1.55), breast lumpectomy (OR 1.35, 95% CI 1.24-1.47), MIS ventral hernia repair (OR 1.21, 95% CI 1.15-1.27), MIS sleeve gastrectomy (OR 2.52, 95% CI 1.86-3.40), parathyroidectomy (OR 1.22, 95% CI 1.13-1.32), and total thyroidectomy (OR 1.51, 95% CI 1.40-1.62). Overall, this study demonstrated that the COVID-19 pandemic was associated with higher rates of outpatient surgery for some general surgery procedures, leading to potential future studies assessing the implications of this increased outpatient surgery load.

Click to read the study in JAMA Network Open

Image: PD

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