Dataset Information

Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.

ABSTRACT:

Importance

The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level.

Objective

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.

Design setting and participants

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.

Main outcomes and measures

Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity.

Results

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.

Conclusions and relevance

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.

SUBMITTER: Tsai TC

PROVIDER: S-EPMC8796934 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.

Tsai Thomas C TC Bryan Ava Ferguson AF Rosenthal Ning N Zheng Jie J Orav E John EJ Frakt Austin B AB Figueroa Jose F JF

JAMA health forum 20211223 12

<h4>Importance</h4>The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level.<h4>Objective</h4>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.<h4>Design setting and participants</h4>This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthc ...[more]

PMID: 35977293

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Project description:ImportanceRacial and ethnic inequities in COVID-19 mortality have been well documented, but little prior research has assessed the combined roles of race and ethnicity and educational attainment.ObjectiveTo measure inequality in COVID-19 mortality jointly by race and ethnicity and educational attainment.Design, setting, and participantsThis cross-sectional study analyzed data on COVID-19 mortality from the 50 US states and the District of Columbia for the full calendar year 2020. It included all persons in the United States aged 25 years or older and analyzed them in subgroups jointly stratified by age, sex, race and ethnicity, and educational attainment.Main outcomes and measuresPopulation-based cumulative mortality rates attributed to COVID-19.F.ResultsAmong 219.1 million adults aged 25 years or older (113.3 million women [51.7%]; mean [SD] age, 51.3 [16.8] years), 376 125 COVID-19 deaths were reported. Age-adjusted cumulative mortality rates per 100 000 ranged from 54.4 (95% CI, 49.8-59.0 per 100 000 population) among Asian women with some college to 699.0 (95% CI, 612.9-785.0 per 100 000 population) among Native Hawaiian and Other Pacific Islander men with a high school degree or less. Racial and ethnic inequalities in COVID-19 mortality rates remained when comparing within educational attainment categories (median rate ratio reduction, 17% [IQR, 0%-25%] for education-stratified estimates vs unstratified, with non-Hispanic White individuals as the reference). If all groups had experienced the same mortality rates as college-educated non-Hispanic White individuals, there would have been 48% fewer COVID-19 deaths among adults aged 25 years or older overall, including 71% fewer deaths among racial and ethnic minority populations and 89% fewer deaths among racial and ethnic minority populations aged 25 to 64 years.Conclusions and relevancePublic health research and practice should attend to the ways in which populations that share socioeconomic characteristics may still experience racial and ethnic inequity in the distribution of risk factors for SARS-CoV-2 exposure and infection fatality rates (eg, housing, occupation, and prior health status). This study suggests that a majority of deaths among racial and ethnic minority populations could have been averted had all groups experienced the same mortality rate as college-educated non-Hispanic White individuals, thus highlighting the importance of eliminating joint racial-socioeconomic health inequities.

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Dataset Information

Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.

Importance

Objective

Design setting and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity.

Similar Datasets

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