“It is important to evaluate ourselves as a microcosm of the larger medical industry to assess how we recovered from the COVID-19 pandemic and to what extent,” Marc Succi, MD, explains. “We sought to determine how deep the initial surgical volume contraction was during the pandemic and what role mass vaccination had on our ability to recover surgical volumes.”

For a paper published in JAMA Network Open, Dr. Succi, Soham Ghoshal, BA, and colleagues conducted a cohort study that examined how surgical volumes changed at a 1,017-bed academic center due to the COVID-19 pandemic. They retrospectively analyzed a total of 129,596 records from surgical procedures during four time periods: pre–COVID-19 (January 6, 2019 to January 4, 2020), COVID-19 peak (March 15, 2020 to May 2, 2020), post–COVID-19 peak (May 3, 2020 to January 2, 2021), and post-vaccine release (January 3, 2021 to December 31, 2021). The researchers measured surgical volumes according to subspecialty and case classes, including elective, emergent, non-urgent, and urgent.

Surgical Volume Declines Across All Specialties, With Limited Recovery

In the peak COVID-19 period, overall weekly surgical procedural volume fell by nearly half— 44.6%—compared with pre-COVID-19 levels (mean procedures per week, 732.37; P<0.001) across all surgical subspecialties. The largest reductions in volume were observed in laryngeal surgery (−77.0%; P<0.001), plastic surgery (−73.9%; P<0.001), oral maxillofacial surgery (−68.8%; P<0.001), and general surgery (−59.7%; P<0.001). Surgical subspecialties that were impacted the least included emergent or urgent surgery (−26.2%; P<0.001) and cardiac surgery (−27.4%; P=0.001).

In the post–COVID peak period, overall weekly surgical volumes (mean procedures per week, 624.31) returned to only 85.8% of pre-COVID peak volumes (P<0.001). Specialties with the most limited recovery included surgical oncology (72.2% of baseline; P<0.001), oral maxillofacial surgery (80.5% of baseline; P<0.001), and laryngeal surgery (80.9% of baseline; P=0.02). Emergent or urgent surgery, neurosurgery, and vascular surgery returned to their respective pre-COVID-19 volumes.

During the post-vaccine release period, which started approximately 2 weeks after the first phase of the COVID-19 vaccine rollout began for clinical and non-clinical healthcare workers, mean overall volume of surgical procedures per week was 672.55, which remained significantly below pre-COVID-19 baseline levels (92.9% of baseline; P<0.001).

“Every subspecialty experienced significant declines in surgical volume during the COVID-19 peak (Table),” Ghoshal says. “During both the post COVID-19 peak and post-vaccine periods, there was inconsistent volume recovery across the different subspecialties. Subspecialties that did not recover to pre-COVID volumes include cardiac surgery, urology, orthopedic surgery, surgical oncology, and thoracic surger.”

An unexpected finding, according to the researchers, was that—while emergent or urgent surgery and vascular surgery recovered procedural volumes in the post-COVID-19 period—there were additional significant declines among these subspecialties in the post–vaccine release period to 94.5% of baseline (P<0.001) and 92.0% of baseline (P<0.001), respectively.

“Despite incredible strides in this once-in-a lifetime pandemic, the fact that we still have not reached pre-pandemic surgical caseloads tells us that patients are not receiving the full surgical care they need at this moment,” Dr. Succi says. “Moreover, looking at specific surgical subspecialties, such as surgical oncology, tells us that the reasons for decreased caseloads can be multifactorial. This includes less imaging for patients with cancer, as we reporte previously, which likely reduces referrals for this category of surgeries. Knowledge of how departments interact is crucial when we talk about increasing operational workflows and managing future pandemics.”

Assessing the Impact of Delayed Care

The results of the current study “tell us we need to increase awareness and operational capacity to schedule deferred surgeries,” Dr. Succi continues.

“Ultimately, the fear is that patients who needed surgeries in a certain timeframe did not, or still have not, received the necessary care, and this may signify future increased morbidity/mortality,” he says.

Future research, as well as changes at the hospital level, are necessary to manage the backlog of surgical procedures that remain and restore volumes to pre-COVID-19 volumes, according to the study results.

“We need to drill down to a deeper level on which patients’ surgeries were delayed and what their clinical outcomes were, or are estimated to be, as our surgical case classes are rather general and could obscure more granular findings,” Dr. Succi explains.