Tsai Thomas C, Brownlee Sarah A, Dai Dannie, Soto Mark, Rosenthal Ning, Orav Endel J, Frakt Austin B, Figueroa Jose F
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Ann Surg. 2025 May 1;281(5):779-786. doi: 10.1097/SLA.0000000000006309. Epub 2024 Apr 25.
To assess the shift from inpatient to outpatient surgical care related to changes to the inpatient-only list in 2020 and 2021 compared with 2019.
The extent to which procedures shift from the inpatient to outpatient setting after removal from Medicare's inpatient-only (IPO) list is unknown. Many health systems also encouraged a shift from inpatient to outpatient surgery during the coronavirus disease 2019 (COVID-19) pandemic. Assessing the relative change in outpatient surgical utilization for procedures removed from the IPO list during COVID-19 would provide empirical data on whether reimbursement policy changes or inpatient capacity needs during the pandemic were more likely to shift care from the inpatient to the outpatient setting.
We used administrative data from the PINC AI Healthcare Database across 723 hospitals to determine the within-facility relative change in outpatient versus inpatient procedural volume in 2020 and 2021 compared with 2019 using a multivariable conditional fixed-effect Poisson regression model. We also assessed whether outpatient surgical utilization varied by race and ethnicity. Using a multivariable linear probability model, we assessed the absolute change in risk-adjusted 30-day complication, readmission, and mortality rates for inpatient and outpatient surgical procedures.
In 2020 and 2021, compared with 2019 respectively, there was a 5.3% (95% CI: 1.4% to 9.5%) and 41.3% (95% CI: 33.1% to 50.0%) relative increase in outpatient elective procedural volume. Outpatient procedural volume increased most significantly for hip replacement which was removed from the IPO list in 2020 [increase in outpatient surgical utilization of 589.3% (95% CI: 524.9% to 660.3%)]. The shift to outpatient hip replacement procedures was concentrated among White patients; in 2021, hip replacement procedural volume increased by 271.1% (95% CI: 241.2% and 303.7%) for White patients and 29.5% (95% CI: 24.4% and 34.9%) for Black patients compared with 2019 levels. There were no consistent or large changes in 30-day complication, readmission, or mortality risk in 2020 and 2021 compared with 2019.
There was a modest increase in elective outpatient surgeries and a pronounced increase in outpatient orthopedic surgeries which were removed from the IPO list during the COVID-19 pandemic. Utilization of outpatient surgical procedures was concentrated among White patients.
评估与2019年相比，2020年和2021年因仅限住院清单变化而导致的手术护理从住院向门诊的转变。
从医疗保险的仅限住院（IPO）清单中移除后，手术程序从住院环境向门诊环境转变的程度尚不清楚。在2019冠状病毒病（COVID-19）大流行期间，许多医疗系统也鼓励从住院手术向门诊手术转变。评估在COVID-19期间从IPO清单中移除的手术程序的门诊手术利用率的相对变化，将提供关于大流行期间报销政策变化或住院能力需求是否更有可能将护理从住院环境转变为门诊环境的实证数据。
我们使用了来自723家医院的PINC AI医疗数据库的行政数据，通过多变量条件固定效应泊松回归模型，确定2020年和2021年与2019年相比各机构内门诊与住院手术量的相对变化。我们还评估了门诊手术利用率是否因种族和民族而异。使用多变量线性概率模型，我们评估了住院和门诊手术程序在风险调整后的30天并发症、再入院和死亡率的绝对变化。
与2019年相比，2020年和2021年门诊择期手术量分别相对增加了5.3%（95%CI：1.4%至9.5%）和41.3%（95%CI：33.1%至50.0%）。2020年从IPO清单中移除的髋关节置换术的门诊手术量增加最为显著[门诊手术利用率增加了589.3%（95%CI：524.9%至660.3%）]。向门诊髋关节置换手术的转变集中在白人患者中；与2019年水平相比，2021年白人患者的髋关节置换手术量增加了271.1%（95%CI：241.2%和303.7%），黑人患者增加了29.5%（95%CI：24.4%和34.9%）。与2019年相比，2020年和2021年30天并发症、再入院或死亡风险没有一致或大幅变化。
在COVID-19大流行期间，择期门诊手术有适度增加，从IPO清单中移除的门诊骨科手术有显著增加。门诊手术程序的利用率集中在白人患者中。
