Epstein Richard H, Dexter Franklin, Smaka Todd J, Candiotti Keith A
Anesthesiology, University of Miami Miller School of Medicine, Miami, USA.
Anesthesiology, University of Iowa, Iowa City, USA.
Cureus. 2020 Aug 14;12(8):e9746. doi: 10.7759/cureus.9746.
A large number of inpatients with Coronavirus disease 2019 (COVID-19) in some regions of the United States may interfere with the ability of hospitals to take care of patients requiring treatment for other conditions. Nonetheless, many patients need surgery to improve their quality of life and to prevent deterioration in health. Curtailment of services also negatively affects the financial health of hospitals and health systems. Broad policies to prohibit all "elective" surgical procedures to ensure that there is sufficient hospital capacity for pandemic patients may be unnecessarily restrictive because, for many such procedures, patients are rarely admitted following surgery or only stay overnight. We studied all elective inpatient and ambulatory cases involving major therapeutic procedures performed in the state of Florida in 2018. We mapped the primary procedure to the corresponding Clinical Classification Software (CCS) category. We determined the distributions of lengths of stay overall and as stratified by CCS category, then calculated the percentage of cases that had a hospital length of stay of ≤1 night (i.e., 0 or 1 day). A threshold of one night was selected because patients discharged home on the day of surgery have no effect on the inpatient census, and those staying overnight would either have a transient effect or no effect if observed overnight in the postoperative care unit. Among the 1,852,391 elective cases with one or more major therapeutic procedures, 65.2% (95% lower confidence limit [LCL] = 65.1%) of cases had a length of stay of 0 days and 72.9% (95% LCL = 72.8%) had stay ≤1 day. There were 38 different CCS categories for which at least 95% of patients had a length of stay of ≤1 day. There were 28 CCS codes that identified 80% of the patients who were discharged with a length of stay ≤1 day, showing representation of multiple surgical specialties. Our results show that even in the face of constraints imposed by a high hospital census, many categories of major therapeutic elective procedures could be performed without necessarily compromising hospital capacity. Most patients will be discharged on the day of surgery. If overnight admission is required, there would be an option to care for them in the postanesthesia care unit, thus not affecting the census. Thus, policies can reasonably be based on allowing cases with a substantial probability of at most an overnight stay rather than a blanket ban on "elective" surgery or creating a carve-out for specified surgical subspecialties. Such policies would apply to at least 72% of elective, major therapeutic surgical procedures.
在美国一些地区，大量2019冠状病毒病（COVID-19）住院患者可能会干扰医院照顾其他疾病所需治疗患者的能力。尽管如此，许多患者仍需要手术来改善生活质量并防止健康状况恶化。服务缩减也会对医院和医疗系统的财务状况产生负面影响。禁止所有“择期”手术程序以确保有足够医院容量收治大流行患者的广泛政策可能限制过多，因为对于许多此类手术，患者术后很少住院或仅住院一晚。我们研究了2018年在佛罗里达州进行的所有涉及主要治疗程序的择期住院和门诊病例。我们将主要手术程序对应到相应的临床分类软件（CCS）类别。我们确定了总体住院时间分布以及按CCS类别分层的分布情况，然后计算住院时间≤1晚（即0或1天）的病例百分比。选择1晚作为阈值是因为手术当天出院的患者对住院人数无影响，而那些过夜住院的患者，如果在术后护理单元过夜观察，要么只有短暂影响，要么无影响。在1,852,391例有一项或多项主要治疗程序的择期病例中，65.2%（95%置信下限[LCL]=65.1%）的病例住院时间为0天，72.9%（95%LCL=72.8%）的病例住院时间≤1天。有38个不同的CCS类别，其中至少95%的患者住院时间≤1天。有28个CCS编码识别出80%住院时间≤1天出院的患者，涵盖多个外科专业。我们的结果表明，即使面对高住院人数带来的限制，许多主要治疗性择期手术类别仍可进行，而不一定会影响医院容量。大多数患者将在手术当天出院。如果需要过夜住院，可以选择在麻醉后护理单元对其进行护理，从而不影响住院人数。因此，政策可以合理地基于允许极有可能最多过夜住院的病例，而不是全面禁止“择期”手术或为特定外科亚专业设立例外情况。此类政策将适用于至少72%的择期主要治疗性外科手术。
