Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, 30 N 1900 E 3b400, Salt Lake City, UT, 84132, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Langenbecks Arch Surg. 2022 Dec;407(8):3727-3733. doi: 10.1007/s00423-022-02605-6. Epub 2022 Jul 20.
The COVID-19 pandemic led to unprecedented changes in volume and quality of surgery. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, the current study assesses the impact of COVID-19 on surgical volume during each quarter of 2020 in comparison to 2019. Quality of surgical care during 2020 was also investigated by assessing postoperative complications, readmissions, and reoperations during 2020 in comparison to the previous 5 years.
The NSQIP database was queried from 2015 to 2020. Descriptive statistics and a chi-squared test were utilized to compare demographic variables. A seasonal autoregressive integrated moving average time-series model was fit to assess the trend and seasonality of complications from 2015 to 2019 and was used to forecast the proportion of complications in the year 2020 and compared the forecast with the actual proportions graphically.
There were fewer patients operated on in 2020 compared to 2019, with the most dramatic drop in Q2 with a nearly 27% decrease. Patients with ASA class 3 or greater were operated on at a greater proportion in every quarter of 2020. Q2 of 2020 represented the highest proportion of any operative complications since 2015 at ~13%. Q4 of 2020 demonstrated a return to 2020 Q1 complication proportions.
Surgical volume was heavily affected in 2020, particularly in Q2. Patients during Q2 of 2020 were generally of a higher ASA class and had increased operative complications. Operative volume and overall surgical complication rate normalized over the next two quarters.
COVID-19 大流行导致手术数量和质量发生了前所未有的变化。本研究利用美国外科医师学会国家外科质量改进计划（NSQIP）数据库，评估了 2020 年每个季度与 2019 年相比 COVID-19 对手术量的影响。还通过评估 2020 年与前 5 年相比的术后并发症、再入院和再次手术情况，来研究 2020 年手术护理质量。
从 2015 年至 2020 年对 NSQIP 数据库进行了查询。利用描述性统计和卡方检验比较了人口统计学变量。拟合季节性自回归综合移动平均时间序列模型，以评估 2015 年至 2019 年并发症的趋势和季节性，并用于预测 2020 年并发症的比例，并将预测值与实际比例进行图形比较。
与 2019 年相比，2020 年接受手术的患者较少，2020 年第二季度降幅最大，接近 27%。ASA 分级 3 或更高的患者在 2020 年每一季度的手术比例都更高。2020 年第二季度是自 2015 年以来任何手术并发症比例最高的季度，约为 13%。2020 年第四季度的并发症比例恢复到 2020 年第一季度的水平。
2020 年手术量受到了严重影响，尤其是在第二季度。2020 年第二季度的患者通常 ASA 分级更高，手术并发症更多。接下来的两个季度手术量和整体手术并发症率恢复正常。
