Mortality from General Surgical Procedures: A Comparison of the Pre-Versus Peri-COVID Era
Author(s)
Elangovanraaj N1, Holy C2, Shah S1, Krishnan D3, Gupta S4, Trivedi P1, Devulapally M1, Mohapatra A1, Johnston S5, Coplan P6
1Mu Sigma, Bangalore, KA, India, 2Johnson & Johnson, Somerville, MA, USA, 3Mu Sigma, Bengaluru, KA, India, 4Mu Sigma, Bangalore, India, 5Johnson & Johnson, Annapolis, MD, USA, 6Johnson & Johnson, New Brunswick, NJ, USA
OBJECTIVES: The SARS-CoV-2 pandemic created significant stress on healthcare systems worldwide, and the impact thereof on patients’ care is unknown. This study was designed to evaluate changes in healthcare delivery in the US during the COVID-19 era and evaluate whether patients that required surgical care during that time were at greater risk for mortality compared to similar patients treated in years prior. METHODS: Patients from the Premier Healthcare Database undergoing surgical procedures from March 1st to May 31st, 2020 (covid_era) and March 1st to May 31st, 2019 (pre-covid_era) were identified and categorized by surgery type. Patients were characterized by demographic, comorbidities, and whether they had a diagnosis for COVID-19 (post April 1st). Length of hospital stay (LOS) and mortality rate for each surgical category were evaluated. Generalized linear models (GLM) were used to test for statistical differences in mortality (family: binomial, link: log), adjusting for demographics, comorbidities and presence of COVID-19 diagnosis. RESULTS: Twenty-four different surgical categories based on major anatomy were identified, such as cardiac and brain surgery. Overall, average LOS decreased from the pre_covid_era to the covid_era from 4.62 days (standard deviation (SD): 5.01) to 4.59 days (SD: 4.51, p = 0.013). Patients treated in the inpatient setting during the covid_era had more comorbidities than during the pre_covid_era (average Elixhauser score: 3.20 vs 3.00, p=0.000). Mortality between both eras in patients was comparable, except for brain surgery (OR: 1.29, 95%CI: 1.03-1.62) and gastrointestinal surgery (OR: 1.15, 95% CI: 1.02-1.30). CONCLUSIONS: Patients admitted for surgical procedures during the COVID_era were sicker and had shorter LOS than in prior years. However, adjusted mortality rates did not change for 22 of 24 surgical categories and only showed slight increases for 2 out of 24 categories. These modest changes might be due to the presence of underdiagnosed COVID-19 patients in surgical cohorts during the COVID-19 era.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PMU3
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Clinical Outcomes Assessment, Disease Classification & Coding, Public Health
Disease
Infectious Disease (non-vaccine), Multiple Diseases