Stanford Medicine researchers found that after the March 2020 COVID-19 shutdown, nonurgent surgery rates dropped, but within months they bounced back and remained at pre-pandemic levels, even as coronavirus infections peaked during the fall and winter of 2020.
The study, published online Dec. 8 in JAMA Network Open, contradicts the assumption that the COVID-19 pandemic has continually curtailed nonessential surgeries across the country.
It's an untold story. It's the opposite of what all the headlines say."
Sherry Wren, MD, professor of general surgery and senior author on the paper
Using administrative claims from more than 13 million surgical procedures in 49 states, the study compared the number of surgeries performed each week in 2019 with the corresponding week in 2020.
As expected, the researchers found a 48% decrease in surgical volume during the seven weeks after mid-March, when the Centers for Medicare and Medicaid Services recommended that hospitals minimize, postpone or cancel elective surgeries. Elective surgeries include those that are medically necessary but can wait more than a few days.
"If you think back to that time," Wren said, "nobody was sure if they had enough personal protective equipment, and doing operations clearly burns through your PPE. There was also the fear of not having adequate hospital beds and ICU beds and ventilators." In that initial climate of uncertainty and fear, she said, postponing as many surgeries as possible made sense.
Health systems learn to adapt
But 35 days after issuing its initial proclamation to curtail elective surgeries, the Centers for Medicare and Medicaid Services issued safe resumption guidelines, which focused on adequate facilities, pre-procedure COVID-19 testing, and supplies of protective equipment. "If you could manage those things," Wren said, "you could operate.
Mattingly, A.S., et al. (2021) Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2021.38038.