How the COVID-19 Pandemic Affected the Volume and Quality of Surgery in 2020: Data from NSQIP

Abstract

INTRODUCTION: The COVID-19 pandemic led to an unprecedented contraction in surgical volume during 2020. Using the American College of Surgeons NSQIP database, the current study assesses the impact of COVID-19 on surgical volume during each quarter of 2020 in comparison to 2019. Quality of surgical care during 2020 was also investigated by assessing postoperative complication, readmission, and reoperation during 2020 in comparison to the previous 5 years. METHODS: The NSQIP database was queried from 2015 to 2020. Descriptive statistics and a chi-square test were used to compare demographic variables. A seasonal auto regressive integrated moving average time-series model was fit to assess the trend and seasonality of complication from 2015 to 2019 and was used to forecast the proportion of complication in the year 2020 and compared the forecast with the actual proportions graphically. RESULTS: There were fewer patients operated on in every quarter of 2020 compared with 2019, with the most dramatic drop in Q2 with a nearly 27% decrease. Patients with American Society of Anesthesiologists (ASA) Class III or greater were operated on at a greater proportion in every quarter of 2020. Q2 of 2020 represented the highest proportion of any operative complication since 2015 at ~13%. Q4 of 2020 demonstrated a return to 2020 Q1 complication proportions (Figure).FigureCONCLUSION: Surgical volume was heavily affected in 2020, particularly in Q2. Patients during Q2 of 2020 were generally of a higher ASA class and had increased operative complication. Operative volume and overall surgical complication rate normalized over the next two quarters.