Elective Surgery Halt Likely Had Minor Effect on Pandemic ICU Capacity

By Anne Harding

July 14, 2020

NEW YORK (Reuters Health) - Elective surgery accounts for about 13% of intensive care unit (ICU) admissions, according to a review of five years of New York State hospital data.

About 59% of ICU stays were medical admissions, while 28% were emergent/urgent admissions/trauma surgery cases, Dr. Stavros G. Memtsoudis of the Hospital for Special Surgery in New York City and colleagues report in Anesthesia and Analgesia.

The findings suggest efforts to free up beds for COVID-19 patients by cancelling elective surgeries may have had a limited effect on expanding ICU capacity, Dr. Memtsoudis told Reuters Health in a telephone interview. "Despite our best efforts to increase ICU capacity through the cancellation of elective surgery, it's not actually the primary driver of ICU resource utilization."

New York State authorities called a halt to elective surgeries in mid-March 2020 to expand critical care resources stressed by the COVID-19 pandemic, Dr. Memtsoudis and his colleagues explain in their report. To estimate the impact of suspending these surgeries, they looked at 2011-2015 data from the New York Statewide Planning and Research Cooperative System (SPARCS) on statewide ICU admissions and ventilator use.

Their analysis included more than 1.2 million ICU admissions, or about 10% of all hospital admissions. Elective surgery cases represented 13.4% of ICU admissions, while 28% were emergent/urgent/trauma surgery cases and 58.6% were medical admissions.

Mechanical ventilation was required in 26.3% of ICU admissions. Among ventilated patients, 60.8% were medical admissions, 32.8% were emergent/urgent admissions/trauma surgery, and 6.4% were admitted after elective surgery. More than half of the emergent/urgent/trauma surgery admissions required more than 96 hours of invasive ventilation.

The biggest surge in ICU bed capacity in New York during the pandemic likely came from reductions in trauma and medical admissions due to stay-at-home orders, Dr. Memtsoudis noted. Nevertheless, he added, stopping elective surgery was an essential step in pandemic preparations. "Elective surgery is a major income source for most institutions, that's why everyone was so nervous about suspending these activities, but it was necessary to free up much needed resources."

At the peak of the pandemic, the Hospital for Special Surgery was caring for nearly 100 COVID-19 patients on its regular hospital floors and up to 25 COVID patients in its ICU. The hospital has started performing elective surgeries again, with strict rules on limiting visitors and requiring testing and travel restrictions for patients and family members.

SOURCE: https://bit.ly/2ZnW3Lp Anesthesia and Analgesia, online June 23, 2020.