Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Center for Surgery and Public Health, Boston, Massachusetts.
JAMA Health Forum. 2021 Dec 23;2(12):e214214. doi: 10.1001/jamahealthforum.2021.4214. eCollection 2021 Dec.
The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level.
To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities.
This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019.
Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity.
The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: -26.8%; 95% CI, -29.6% to -23.9%; April: -74.6%; 95% CI, -75.5% to -73.5%; December: -13.3%; 95% CI, -16.6%, -9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters.
As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels.
在 COVID-19 大流行期间，手术护理受到的干扰程度尚未在全国范围内进行实证描述。
描述 COVID-19 大流行期间，根据手术紧急程度对手术护理的使用情况，并评估种族和民族差异。
设计、设定和参与者：这是一项回顾性观察性研究，使用了 Premier Healthcare Database 中来自 767 家医院的地理分布广泛、涵盖所有支付方的数据。手术被分为 4 个手术紧急程度队列（择期、非择期、急诊和创伤）。使用具有医院固定效应的广义线性回归模型，评估 2020 年与 2019 年相比，医院内手术量每月相对减少的情况。
结果是整体手术量和各手术紧急程度队列以及种族和民族之间每月相对减少的情况。
样本包括 13 175 087 例住院和门诊手术。与 2019 年相比，2020 年手术使用率下降了 12.6%。在所有手术队列中，就诊量下降最明显的是在 2020 年春季。例如，择期就诊量从 3 月开始下降，4 月达到低谷，随后有所恢复，但从未恢复到疫情前水平（3 月：-26.8%；95%CI，-29.6%至-23.9%；4 月：-74.6%；95%CI，-75.5%至-73.5%；12 月：-13.3%；95%CI，-16.6%至-9.8%）。在所有手术紧急程度队列中，白人患者的就诊量降幅最大。
这项队列研究表明，COVID-19 大流行对所有手术紧急程度类别的手术护理造成了重大干扰，尤其是择期手术。种族和少数民族群体受到的手术护理干扰小于白人患者。需要进一步研究，以探讨白人患者手术量减少是否是由于患者的谨慎考虑，并记录手术护理需求是否会恢复到基线水平。
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