U.S. ignored urgent surgeries during the COVID-19 pandemic

A new study finds that surgical procedures in the United States fell sharply during early pandemic quarantines as health officials treated cancer and other urgent conditions as nonessential.

Published this week in JAMA Surgery, the research letter analyzed anonymous surgery data from insurance claims provided by Change Healthcare. It found the volume of all procedures fell from 560,366 in April 2019 before the pandemic to 258,619 in April 2020 during lockdowns and quarantines.

That includes surgeries for 10 urgent conditions including various cancers, infections and ischemia that declined from 90,656 to 40,093 procedures over the same period.

Lead researcher Sherry M. Wren, director of global surgery at Stanford University’s Center for Global Health and Innovation, said the study sought to better define “essential surgery” for future pandemics.

“There are numerous articles now showing the negative impact the COVID response had on cancer care since there was no schema to guide decision making and some health centers deferred this care,” said Dr. Wren, the director of clinical surgery at Palo Alto Veterans Hospital. “This report can serve as foundational data for planning purposes for high-resourced countries.”

According to the research letter, the World Bank Disease Control Priorities defined 44 essential surgical procedures as a starting point for health systems in low- and middle-income countries early in the pandemic.

Those procedures included soft-tissue surgeries, cesarean deliveries, fracture treatments and appendectomies.

Because the Centers for Medicare and Medicaid Services restricted elective surgery during the pandemic, many conditions not on this list went untreated as nonessential.

The research letter found that these nonessential surgeries included treatments for several cancers: intestinal, urological, cardiothoracic, gynecological, ear, nose, throat and breast.

They also included organ transplants, heart bypasses and aneurysms.

Dr. Amesh A. Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said the study shows the costs of restricting surgical procedures in the early days of COVID.

“The lesson is that it’s not good policy to fall prey to short-range thinking and privilege one health condition such as COVID over others whose impact will also be significant,” said Dr. Adalja, an infectious disease specialist.

With no other list of essential surgeries available during pandemic quarantines, hospitals made judgment calls about allocating staff, beds, supplies and resources for non-COVID patients.

Medical experts say the U.S. can do better next time.

“We as a health care system were not greatly prepared to deal with resource allocation during a public health crisis,” said Dr. Panagis Galiatsatos, a physician at the Johns Hopkins School of Medicine. “Every health system needs to prepare for such issues, from staffing to therapies, and be ready to improve the threshold that would prevent such a pause in health care services.”

For more information, visit The Washington Times COVID-19 resource page.