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. 2021 Jan;25(1):260-268.
doi: 10.1007/s11605-020-04722-3. Epub 2020 Jul 27.

COVID-19 Impact on Colorectal Daily Practice-How Long Will It Take to Catch Up?

Dong Hum Yoon  1 , Sarah Koller  1 , Philip Marjun N Duldulao  1 , Glenn T Ault  1 , Sang W Lee  1 , Kyle G Cologne  2   3
Affiliations

COVID-19 Impact on Colorectal Daily Practice-How Long Will It Take to Catch Up?

Dong Hum Yoon et al. J Gastrointest Surg. 2021 Jan.

Abstract

Background: All elective surgeries have been postponed at our institution starting 3/16/20 due to the COVID-19 pandemic. We assessed changes in hospital resource utilization and estimated the future backlog of cases in the colorectal surgery division of a large safety-net hospital.

Methods: Patients undergoing colorectal procedures from 3/16/20 to 4/23/20 (COVID) were compared with those from January through June 2018 (historical). Resource utilization rates were calculated by weekly case volumes and hospital stay in each group. A future catch up timeframe and new wait times from scheduling to surgery dates were calculated.

Results: The COVID and historical groups included 13 and 239 patients, respectively. The COVID group showed a 74% relative decrease in weekly surgical case rates (9.2 to 2.4 patients per week). Both groups had similar lengths of stay. The COVID group had a longer average ICU stay (1.4 ± 2.5 days vs. 0.4 ± 1.2 days, P = 0.016) and a 132% increase in ICU resource utilization. Overall, the COVID group had a 48% relative decrease in hospital resource utilization, owing to reduced volume but higher acuity. If the surgery numbers returns to pre-COVID volumes, the calculated "catch up" times range from 4.6 weeks to 9.2 weeks. Wait times for new cases may increase by 70% compared with pre-COVID levels.

Conclusion: Cancelling elective colorectal surgeries results in a decrease in overall but increase in ICU-specific resource utilization. Though necessary, cancellations result in an increasing backlog of cases that poses significant future logistical and clinical challenges in an already overburdened safety-net hospital. Effective triage systems will be critical to prioritize this backlog.

Keywords: Backlog; COVID-19; Colorectal surgery; Resource utilization.

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Conflict of interest statement

All authors have no relevant conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
A schematic outline of estimated catch up and new wait times. Based on various hypothetic (modeled) rates of new cases requests per week starting May 31, 2020. (a) new cases/week calculated by pandemic backlog case requests added to historical new case requests for possible upstroke of new cases. (b) After backlog clearance, the new case requests drop back down to historical numbers (i.e., 7.6 new cases per week). (c) Relative increase from baseline wait time (see d). (d) Time between surgery scheduling and day of surgery.
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