Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic

Abstract

In February 2020, US physicians and public health personnel watched in real time the mounting deaths among patients and health care workers with COVID-19 and the associated resource shortages in Europe.^1,2 Soon thereafter, the New York City metropolitan area became the first US epicenter for COVID-19. The most recent pandemic the US had faced, the 2009 influenza A (H1N1) virus pandemic was associated with mortality (0.02%) and hospitalization (0.45%) rates of less than one-half of 1 percent of the estimated 60.8 million people infected.³ In contrast, COVID-19 was associated with unprecedented stress and demands on the New York City health system, with increased rates of mortality (9.6%) and hospitalization (26.6%).⁴ On March 13, 2020, the US president declared a national emergency, leading to a shutdown of all nonessential activities throughout the United States.⁵ The American College of Surgeons (ACS) and other major surgical specialty societies recommended minimizing, postponing, or canceling elective surgical procedures in mid-March and published guidelines for triage of elective procedures by surgical specialty.^6,7 The Centers for Medicare & Medicaid Services (CMS) and US Surgeon General also issued statements and recommendations for postponement of nonessential surgical procedures.^6,8 Recommendations were driven by concerns that continuation of elective surgical treatments could potentially compromise hospital and intensive care unit (ICU) capacity and result in shortages in personal protective equipment (PPE) supplies. In line with national recommendations, 35 states had formal declarations by state governors or medical societies to postpone all nonessential surgical procedures, which was associated with a decrease in surgical procedure volume during the initial months of the pandemic shutdown.⁹