Disproportionate Case Reduction After Ban of Elective Surgeries During the SARS-CoV-2 Pandemic

Abstract

Study design: This is a retrospective case analysis.

Objective: The objective of this study was to illustrate the numerical effects of regulatory restrictions of elective surgery at an orthopaedic university hospital.

Summary of background data: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic all over the world places extraordinary demands on health care systems which are forced to ensure structural and personnel capacities. Consequently, hospitals may only perform urgent interventions. Spine patients, however, often need urgent surgery and, moreover, bear an above-average perioperative risk frequently requiring postoperative surveillance on intensive care units (ICUs). Facing this dilemma, we want to share our practice and its unexpected numerical effects.

Methods: We compare case statistics during normal operation, directly before and after implementation of regulatory measures. We also analyzed the differences in ICU utilization, complexity and duration of interventions and the patient population.

Results: Spine surgical interventions have been reduced by 42.7%. Regulatory restriction of "elective surgeries" in pandemic situations results in reduced ICU utilization, however in a disproportionate manner. Although other specialized surgeries can be reduced by 59%, surgical spine cases are only diminishable by 24%. The spine surgery-related ICU occupancy has been reduced by 35%.

Conclusion: The disproportionate effect of case reduction needs to be considered while calculating resources released by regulatory limitation of "elective surgeries" on a (inter-)national level.