Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic Article Swipe
Omair A. Shariq
,
Katherine A. Bews
,
David A. Etzioni
,
Michael L. Kendrick
,
Elizabeth B. Habermann
,
Cornelius A. Thiels
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2023.1198
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2023.1198
Importance The American College of Surgeons (ACS) has advocated for the expansion of outpatient surgery to conserve limited hospital resources and bed capacity, while maintaining surgical throughput, during the COVID-19 pandemic. Objective To investigate the association of the COVID-19 pandemic with outpatient scheduled general surgery procedures. Design, Setting, and Participants This multicenter, retrospective cohort study analyzed data from hospitals participating in the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from January 1, 2016, to December 31, 2019 (before COVID-19), and from January 1 to December 31, 2020 (during COVID-19). Adult patients (≥18 years of age) who underwent any 1 of the 16 most frequently performed scheduled general surgery operations in the ACS-NSQIP database were included. Main Outcomes and Measures The primary outcome was the percentage of outpatient cases (length of stay, 0 days) for each procedure. To determine the rate of change over time, multiple multivariable logistic regression models were used to assess the independent association of year with the odds of outpatient surgery. Results A total of 988 436 patients were identified (mean [SD] age, 54.5 [16.1] years; 574 683 women [58.1%]), of whom 823 746 underwent scheduled surgery before COVID-19 and 164 690 had surgery during COVID-19. On multivariable analysis, the odds of outpatient surgery during COVID-19 (vs 2019) were higher in patients who underwent mastectomy for cancer (odds ratio [OR], 2.49 [95% CI, 2.33-2.67]), minimally invasive adrenalectomy (OR, 1.93 [95% CI, 1.34-2.77]), thyroid lobectomy (OR, 1.43 [95% CI, 1.32-1.54]), breast lumpectomy (OR, 1.34 [95% CI, 1.23-1.46]), minimally invasive ventral hernia repair (OR, 1.21 [95% CI, 1.15-1.27]), minimally invasive sleeve gastrectomy (OR, 2.56 [95% CI, 1.89-3.48]), parathyroidectomy (OR, 1.24 [95% CI, 1.14-1.34]), and total thyroidectomy (OR, 1.53 [95% CI, 1.42-1.65]). These odds were all greater than those observed for 2019 vs 2018, 2018 vs 2017, and 2017 vs 2016, suggesting that an accelerated increase in outpatient surgery rates in 2020 occurred as a consequence of COVID-19, rather than a continuation of secular trends. Despite these findings, only 4 procedures had a clinically meaningful (≥10%) overall increase in outpatient surgery rates during the study period: mastectomy for cancer (+19.4%), thyroid lobectomy (+14.7%), minimally invasive ventral hernia repair (+10.6%), and parathyroidectomy (+10.0%). Conclusions and Relevance In this cohort study, the first year of the COVID-19 pandemic was associated with an accelerated transition to outpatient surgery for many scheduled general surgical operations; however, the magnitude of percentage increase was small for all but 4 procedure types. Further studies should explore potential barriers to the uptake of this approach, particularly for procedures that have been shown to be safe when performed in an outpatient setting.
Related Topics
Concepts
Medicine
Odds ratio
Retrospective cohort study
Logistic regression
Coronavirus disease 2019 (COVID-19)
Pandemic
Outpatient surgery
Odds
Surgery
General surgery
Emergency medicine
Internal medicine
Ambulatory
Infectious disease (medical specialty)
Disease
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2023.1198
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2801919/shariq_2023_oi_230069_1676919626.70853.pdf
- OA Status
- gold
- Cited By
- 32
- References
- 23
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4322757617
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4322757617Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamanetworkopen.2023.1198Digital Object Identifier
- Title
-
Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 PandemicWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-03-02Full publication date if available
- Authors
-
Omair A. Shariq, Katherine A. Bews, David A. Etzioni, Michael L. Kendrick, Elizabeth B. Habermann, Cornelius A. ThielsList of authors in order
- Landing page
-
https://doi.org/10.1001/jamanetworkopen.2023.1198Publisher landing page
- PDF URL
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2801919/shariq_2023_oi_230069_1676919626.70853.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2801919/shariq_2023_oi_230069_1676919626.70853.pdfDirect OA link when available
- Concepts
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Medicine, Odds ratio, Retrospective cohort study, Logistic regression, Coronavirus disease 2019 (COVID-19), Pandemic, Outpatient surgery, Odds, Surgery, General surgery, Emergency medicine, Internal medicine, Ambulatory, Infectious disease (medical specialty), DiseaseTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
32Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 13, 2024: 16, 2023: 3Per-year citation counts (last 5 years)
- References (count)
-
23Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.multicenter, | 51 |
| abstract_inverted_index.particularly | 417 |
| abstract_inverted_index.adrenalectomy | 229 |
| abstract_inverted_index.multivariable | 145, 200 |
| abstract_inverted_index.participating | 59 |
| abstract_inverted_index.retrospective | 52 |
| abstract_inverted_index.thyroidectomy | 276 |
| abstract_inverted_index.parathyroidectomy | 268, 360 |
| cited_by_percentile_year.max | 100 |
| cited_by_percentile_year.min | 96 |
| corresponding_author_ids | https://openalex.org/A5047120387 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 6 |
| corresponding_institution_ids | https://openalex.org/I1330342723 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8399999737739563 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.98036226 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |