Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery

Abstract

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively. Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

Keywords: cancellation; covid-19; follow-up appointment; general neurosurgery; no-show.

Figure 1. Inclusion and Exclusion Criteria for a) NSCED and b) OCED

NSCED: Neurological Surgery Clinical Encounter Database; OCED: Otolaryngology Clinical Encounter Database

Figure 2. (a) No-show rate, (b) non-attendance rate, (c) late cancellation rate, and (d) cancellation rate calculated over time (red and blue represent the OCED and NSCED respectively; green represents cumulative COVID-19 Cases in Chicago; yellow represents cumulative COVID-19 hospitalizations in Chicago)

Figure 3. Multivariate logistic regression analysis of no-show rates in the NSCED. Forest plot of the adjusted odds ratio based on no-show rates in a) pre-COVID cohort and b) post-COVID cohort (Wald Test, p< 0.1 *, p<0.05 **, p <0.01 ***, p <0.0001 ****), and c) receiver operating curve for the multivariate logistic regression analysis model. AUC (area under the curve) Chi-square of the model compared with chance p<0.0001

NSCED: Neurological Surgery Clinical Encounter Database

Figure 4. Multivariate logistic regression analysis of no-show rates in the OCED. Forest plot of the adjusted odds ratio based on no-show rates in a) pre-COVID cohort and b) post-COVID cohort (Wald Test, p< 0.1 *, p<0.05 **, p <0.01 ***, p <0.0001 ****), and c) receiver operating curve for the multivariate logistic regression analysis model. AUC (area under the curve) Chi-square of the model compared with chance p<0.0001

OCED: Otolaryngology Clinical Encounter Database