A new retrospective cohort study – Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic – confirmed that some common general surgeries had the biggest migrations to the outpatient setting during the first year of the COVID-19 pandemic. And this is likely a favorable trend perhaps reducing the costs of worker’s compensation medical claims.
Compared with the previous few years, calendar year 2020 saw disproportionately more outpatient cases of mastectomy for cancer, minimally invasive adrenalectomy, thyroid lobectomy, breast lumpectomy, minimally invasive ventral hernia repair, minimally invasive sleeve gastrectomy, parathyroidectomy, and total thyroidectomy.
For the present retrospective cohort study, Thiels and colleagues analyzed case volumes for the 16 most common general surgeries in the ACS National Surgical Quality Improvement Program (NSQIP). Outpatient procedures were defined as those that had patients discharged the same day as their procedure.
Patients were split between the 823,746 who received surgery prior to the COVID-19 pandemic (January 2016 through December 2019) and the 164,690 patients who had surgery during the pandemic (January through December 2020). The study population had an average age of 54.5 years and 58.1% were women.
According to a report on this study published by MedPage Today, the increase in outpatient volumes from 2016 to 2020 was deemed clinically significant for the following four procedures:
– – Mastectomy for cancer: 9.2% to 28.6%
– – Thyroid lobectomy: 43.2% to 57.9%
– – Minimally invasive ventral hernia repair: 58.8% to 69.4%
– – Parathyroidectomy: 51.8% to 61.8%
Driving the accelerated transition to outpatient surgeries was the need to simultaneously meet the needs of the massive influx in patients, a result of the COVID-19 pandemic, while still accepting and treating patients in need of non-urgent surgery, according to Cornelius Thiels, DO, MBA, surgical oncologist at the Mayo Clinic in Rochester, Minnesota, and coauthors, writing in JAMA Network Open.
As U.S. hospitals were beginning to buckle under limited resources and the need to mitigate SARS-CoV-2 exposure, the American College of Surgeons (ACS) and other organizations published elective case triage guidelinesopens in a new tab or window in early 2020.
“These guidelines recognize that postoperative inpatient admission uses key hospital resources that need to be allocated toward the care of acutely unwell patients with COVID-19 and exposes patients undergoing routine surgery to the risk of nosocomial COVID-19 infection,” Thiels and colleagues noted.
Adrian Diaz, MD, general surgery resident at The Ohio State University in Columbus, said the study’s findings are consistent with his group’s reported experience before and since the pandemic, and that the trends may continue for years.
Diaz suggested that outpatient surgery may be the preference for many patients. “Often times outpatient surgery is logistically more convenient and patients can return home and to normalcy much faster. Finally, outpatient surgery is often less resource intensive and thereby less expensive, leading to less cost to patients.”
“I believe this study is further evidence that more and more surgery is moving to an outpatient setting. Although this study did not assess safety or outcomes, the trends in the study demonstrate that most providers feel comfortable performing these operations in an outpatient setting,” he told MedPage Today.
The pandemic-era rise of outpatient procedures reportedly also extends to minimally invasive procedures like percutaneous coronary intervention and transcatheter aortic valve replacement, other groups have shown.
Data from the ACS-NSQIP-participating hospitals may not be fully representative of the entire U.S. population, the investigators acknowledged. Another limitation was the possibility of confounding due to surgical patients during the pandemic being sicker overall.