OBJECTIVES: In March 2020, governmental and professional organizations recommended postponing or canceling non-emergent surgeries in the US due to the COVID-19 pandemic. However little research has quantified how hospitals altered their surgical practices across modalities. We aim to identify changes in surgical practice during the peak months of the pandemic and determine if these were heterogeneous across surgical modalities using a nationwide hospital administrative database.

METHODS: The study identified adult patients who had an elective, general surgical encounter including cholecystectomy, colectomy, hernia repair, rectal resection, and sigmoidectomy from 1/2019 to 12/2020 in the Premier Healthcare Database® (PHD). Among hospitals that contributed data to PHD in both years, we compared quarterly year-over-year changes of surgical volumes from 2019 to 2020 and stratified by modality, including open, laparscopic and robotic assisted surgery (RAS). We also conducted a difference-in-difference analysis using Poisson regression to test changes in volumes by modality and quarter.

RESULTS: In 725 hospitals, elective general surgical volumes fell from 15,128 in 2019 to 12,374 in 2020 (-18.2%), with the biggest decline occuring in 2020 Q2 (3,721 Q2 2019 vs 2,477 Q2 2020; -33.4%). Declines in surgical volume varied significantly by surgical modality. Relative to 2019, 2020 volumes for laparoscopic, open, and RAS surgieries fell 24%, 23%, and 7%, respectively. Across all quarters, decline in RAS surgeries was significantly lower than both laparoscopic and open modalities (p<0.05), except Q2 compared to open procedures. No significant difference in volume change between open and laparoscopic surgeries was detected.

CONCLUSION: Declines in elective general surgery were observed in 2020 compared to the corresponding quarters of 2019, with the biggest reduction in Q2 2020. RAS surgery rebounded closer to 2019 baseline in the second half of 2020, relative to laparoscopic and open surgeries. Further investigation should evaluate the impact of delayed or canceled elective surgeries.