During the COVID-19 pandemic, hospitals shifted certain procedures to outpatient settings as they adapted to limited resources and attempted to reduce the risk of coronavirus infections, according to a new study published in JAMA Network Open.

Study details and key findings

For the study, researchers analyzed case volumes for the 16 most common general surgeries in the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Outpatient procedures were defined as procedures where patients were discharged the same day.

Patients were divided into two groups: Those who had received surgery between January 2016 and December 2019 and those who had received surgery between January and December 2020.

There were 823,746 patients who received surgery before the pandemic, and 164,690 patients who received surgery during the pandemic. Among the patients, the average age was 54.5 years, and 58.1% were women.

Overall, the researchers found that there were a disproportionate number of outpatient cases for eight common surgeries in 2020 compared to the few years prior to the pandemic. Four procedures also had a clinically significant absolute increase in outpatient volumes between 2016 and 2020, including mastectomy for cancer, thyroid lobectomy, minimally invasive ventral hernia repair, and parathyroidectomy.

According to the researchers, the increased transition to outpatient surgeries for certain procedures was driven by the need to care for the surges of COVID-19 patients while also accepting and treating patients who required non-urgent surgeries.

In early 2020, the American College of Surgeons and other organizations published elective case triage guidelines to help hospitals more effectively balance their limited resources and reduce coronavirus infections.

"These guidelines recognize that postoperative inpatient admission uses key hospital resources that need to be allocated toward the care of acutely unwell patients with COVID-19 and exposes patients undergoing routine surgery to the risk of nosocomial COVID-19 infection," the researchers wrote.

Commentary

According to Adrian Diaz, a general surgery resident at The Ohio State University, the study's findings are in line with his group's experience both before and since the pandemic began. Other research suggests that the rise of outpatient procedures during the pandemic has also included minimally invasive procedures, such as percutaneous coronary intervention and transcatheter aortic valve replacement.

"I believe this study is further evidence that more and more surgery is moving to an outpatient setting," Diaz said. "Although this study did not assess safety or outcomes, the trends in the study demonstrate that most providers feel comfortable performing these operations in an outpatient setting."

In addition, Diaz noted that the trend to more outpatient procedures is likely to continue, especially since many patients may prefer outpatient surgery. "Often times outpatient surgery is logistically more convenient and patients can return home and to normalcy much faster," he said. "Finally, outpatient surgery is often less resource intensive and thereby less expensive, leading to less cost to patients." (Short, MedPage Today, 3/3; Shariq et al., JAMA Network Open, 3/2)