Vermont Business Magazine Newly published study results from the VA Disrupted Care National Project (DCNP) reveal that the number of surgical procedures fell more during later waves of the COVID-19 pandemic than they had during the early waves, leading researchers to believe that instead of health systems learning to manage surgical needs over the course of the pandemic, they increasingly struggled to support patients’ surgical needs as the pandemic progressed.
A multi-institutional team of researchers led by the White River Junction VA and including the West Haven and Palo Alto VA analyzed over 1.8 million surgical procedures using Medicare claims activity from 2016 to 2021. The analysis yielded important insight by identifying two periods of marked decline in surgeries.
The first period of decline was in the second quarter of 2020, at the time the pandemic was declared, and the first wave of infections and hospitalizations occurred. The second period of significant decline occurred during the fourth quarter of 2021, when the Omicron variant of COVID-19 was dominant and causing substantial rates of infection and hospitalization.
Prior to the pandemic, the volume of surgical procedures saw average annual second quarter increases of 9.35% and fourth quarter increases of nearly 6%. In contrast, volume decreased by over 32% during the second quarter of 2020 and 36% during the fourth quarter of 2021.
During the first year of the pandemic, in March 2020, the American College of Surgeons recommended postponing elective procedures amid the COVID-19 pandemic. However, the decline in surgical procedures was not limited to elective procedures. In fact, the VA DCNP researchers saw declines regardless of medical urgency, otherwise known as ‘acuity’.
Initially, shortly after the declaration of the pandemic, there was a greater decline in low and intermediate acuity surgical procedures than for high acuity procedures, the most medically urgent surgical cases, where life and limb are at risk. This demonstrates a clear shift to move resources from lower urgency surgeries such as colonoscopies or varicose vein treatments to higher urgency, life-or-limb saving procedures such as tracheostomy, abdominal aortic aneurysm or limb threatening vascular surgeries.
However, as the pandemic wore on, during the fourth quarter of 2021, a different trend emerged. Notably, there was a profound decline in how often high acuity surgical procedures were being done, the most medically urgent surgical cases. This is a larger decrease than was seen during the first year of the pandemic. In fact, there was a nearly 47% decline in high acuity procedures compared to an average of 40% and 44% respectively for low and medium acuity procedures.
According to Louise Davies, MD, MS lead author, White River Junction VA, “We believe the profound decline in high acuity procedures during the second period of decline suggests the strain on the US healthcare system exceeded our ability to respond or re-allocate resources.”
As data beyond 2021 becomes available, the VA research team hopes to gain additional insights into healthcare system performance and recovery by investigating resource allocation and shortages, operating room utilization, staffing patterns, bed availability, patient transfers, and cancer and emergency care, to support future preparedness planning.
Davies explains, “Results from the DCNP, including what we’ve seen in this recent study, could help preparedness planning aiming to protect access to necessary lifesaving surgical care during times of stress to our healthcare system.”
For further information about this study, please contact the White River Junction Public Affairs Office at 802-295-9363 x5890 or [email protected].
Source: 5.14.2024. White River Junction, VT- VA Healthcare System
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