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. 2021 Dec:268:181-189.
doi: 10.1016/j.jss.2021.06.009. Epub 2021 Jun 16.

Operative Shutdown and Recovery: Restructuring Surgical Operations During the SARS-CoV-2 Pandemic

Paul H McClelland  1 , Olivia Cheng  2 , James Hu  2 , John G Hunter  2 , Alfred C Winkler  2 , Roseanna Lee  2 , Michael E Zenilman  2
Affiliations

Operative Shutdown and Recovery: Restructuring Surgical Operations During the SARS-CoV-2 Pandemic

Paul H McClelland et al. J Surg Res. 2021 Dec.

Abstract

Background: During the 2020 SARS-CoV-2 outbreak in New York City, hospitals canceled elective surgeries to increase capacity for critically ill patients. We present case volume data from our community hospital to demonstrate how this shutdown affected surgical care.

Methods: Between March 16 and June 14, 2020, all elective surgeries were canceled at our institution. All procedures performed during this operating room shutdown (ORS) were logged, as well as those 4 weeks before (PRE) and 4 weeks after (POST) for comparison.

Results: A total of 2,475 cases were included in our analysis, with 754 occurring during shutdown. Overall case numbers dropped significantly during ORS and increased during recovery (mean 245.0 ± 28.4 PRE versus 58.0 ± 30.9 ORS versus 186.0±19.4 POST cases/wk, P< 0.001). Emergency cases predominated during ORS (26.4% PRE versus 59.3% ORS versus 31.5% POST, P< 0.001) despite decreasing in frequency (mean 64.5 ± 7.9 PRE versus 34.4 ± 12.1 ORS versus 58.5 ± 4.0 POST cases/wk, P< 0.001). Open surgeries remained constant in all three phases (52.2-54.1%), whereas laparoscopic and robotic surgeries decreased (-3.4% and -3.0%, P< 0.001). General and/or vascular surgery, urology, and neurosurgery comprised a greater proportion of caseload (+9.5%, +3.0%, +2.8%), whereas orthopedics, gynecology, and otolaryngology/plastic surgery all decreased proportionally (-5.0%, -4.4%, -5.9%, P< 0.001).

Conclusion: Operative volume significantly decreased during the SARS-CoV-2 outbreak. Emergency cases predominated during this time, although there were fewer emergency cases overall. General/vascular surgery became the most active service and open surgeries became more common. This reallocation of resources may be useful for future crisis planning among community hospitals.

Keywords: COVID-19; General surgery; Operating room; Quality improvement; Resource allocation; SARS-CoV-2.

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Figures

Fig 1
Fig. 1
Operating room weekly case totals through the 21-wk study period. Case totals sharply decreased after cancellation of elective cases, followed by gradual increase during recovery as restrictions were lifted. Color version of figure is available online.
Fig 2
Fig. 2
Operating room weekly case totals categorized by emergency status (top panel, A) and surgical approach (bottom panel, B). Top panel: non-emergency (blue) versus emergency (red). Bottom panel: intravascular (red) versus minimally invasive (green) versus open (blue) versus robotic (purple). Color version of figure is available online.
Fig 3
Fig. 3
Operating room average case rates per wk (top panel) and percentage of total caseload (bottom panel). Specialties are denoted by color: general/vascular surgery (blue), orthopedics/podiatry (orange), obstetrics/gynecology (purple), otolaryngology/plastics/hand/dental surgery (red), urology (green), and neurosurgery (brown). Color version of figure is available online.
See this image and copyright information in PMC

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