Abstract
A large number of inpatients with Coronavirus disease 2019 (COVID-19) in some regions of the United States may interfere with the ability of hospitals to take care of patients requiring treatment for other conditions. Nonetheless, many patients need surgery to improve their quality of life and to prevent deterioration in health. Curtailment of services also negatively affects the financial health of hospitals and health systems. Broad policies to prohibit all “elective” surgical procedures to ensure that there is sufficient hospital capacity for pandemic patients may be unnecessarily restrictive because, for many such procedures, patients are rarely admitted following surgery or only stay overnight. We studied all elective inpatient and ambulatory cases involving major therapeutic procedures performed in the state of Florida in 2018. We mapped the primary procedure to the corresponding Clinical Classification Software (CCS) category. We determined the distributions of lengths of stay overall and as stratified by CCS category, then calculated the percentage of cases that had a hospital length of stay of ≤1 night (i.e., 0 or 1 day). A threshold of one night was selected because patients discharged home on the day of surgery have no effect on the inpatient census, and those staying overnight would either have a transient effect or no effect if observed overnight in the postoperative care unit. Among the 1,852,391 elective cases with one or more major therapeutic procedures, 65.2% (95% lower confidence limit [LCL] = 65.1%) of cases had a length of stay of 0 days and 72.9% (95% LCL = 72.8%) had stay ≤1 day. There were 38 different CCS categories for which at least 95% of patients had a length of stay of ≤1 day. There were 28 CCS codes that identified 80% of the patients who were discharged with a length of stay ≤1 day, showing representation of multiple surgical specialties. Our results show that even in the face of constraints imposed by a high hospital census, many categories of major therapeutic elective procedures could be performed without necessarily compromising hospital capacity. Most patients will be discharged on the day of surgery. If overnight admission is required, there would be an option to care for them in the postanesthesia care unit, thus not affecting the census. Thus, policies can reasonably be based on allowing cases with a substantial probability of at most an overnight stay rather than a blanket ban on “elective” surgery or creating a carve-out for specified surgical subspecialties. Such policies would apply to at least 72% of elective, major therapeutic surgical procedures.
Highlights
The census of inpatients infected with the SARS-CoV-2 virus is high at many hospitals in the United States, interfering with the ability to take care of patients requiring treatment for conditions other than Coronavirus disease 2019 (COVID-19) [1]
Among the 1,852,391 elective cases with one or more major therapeutic procedures, 65.2% (95% lower confidence limit [LCL] = 65.1%) of cases had a length of stay of 0 days and 72.9% (95% LCL = 72.8%) had stay ≤1 day
To determine if a Current Procedure Terminology® (CPT) code was for a major therapeutic procedure, we determined if the associated surgery flag field for the code had a value of “narrow.” For mapping CPT procedure codes to the corresponding Classification Software (CCS) category, we used the “2019 CCS-Services and Procedures Software” [17]
Summary
The census of inpatients infected with the SARS-CoV-2 virus is high at many hospitals in the United States, interfering with the ability to take care of patients requiring treatment for conditions other than Coronavirus disease 2019 (COVID-19) [1]. There would be no rationale to restrict patients from having elective cataract surgery based solely on concern on the availability of inpatient beds because those patients are rarely admitted to hospitals following their procedure [5,6]. There could be a reason to restrict care based on other factors such as the absence of sufficient quantities of personal protective equipment, lack of availability of timely preoperative reverse transcriptase-polymerase chain reaction testing for SARS-CoV-2, or inadequate numbers of healthy medical personnel [7]. In Florida, the executive order by Governor DeSantis that stopped all elective surgery was issued on March 20, 2020, because “... appropriate steps must be taken to conserve all medical supplies, including personal protective equipment...” [8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
