Acute Care Resource Use After Elective Surgery in the United States

Implications During the COVID-19 Pandemic

Vijay Krishnamoorthy, MD, MPH, PhD; Tetsu Ohnuma, MD, MPH, PhD; Raquel Bartz, MD, MMCi; Matthew Fuller, MS; Nita Khandelwal, MD, MS; Krista Haines, DO, MA; Charles Scales, MD; Karthik Raghunathan, MD, MPH

Disclosures

Am J Crit Care. 2021;30(4):320-324. 

In This Article

Abstract and Introduction

Abstract

Background: The COVID-19 pandemic created pressure to delay inpatient elective surgery to increase US health care capacity. This study examined the extent to which common inpatient elective operations consume acute care resources.

Methods: This cross-sectional study used the Premier Healthcare Database to examine the distribution of inpatient elective operations in the United States from the fourth quarter of 2015 through the second quarter of 2018. Primary outcomes were measures of acute care use after 4 common elective operations: joint replacement, spinal fusion, bariatric surgery, and coronary artery bypass grafting. A framework for matching changing demand with changes in supply was created by overlaying acute care data with publicly available outbreak capacity data.

Results: Elective coronary artery bypass grafting (n = 117 423) had the highest acute care use: 92.8% of patients used intensive care unit beds, 89.1% required postoperative mechanical ventilation, 41.0% required red blood cell transfusions, and 13.3% were readmitted within 90 days of surgery. Acute care use was also substantial after spinal fusion (n = 203 789): 8.3% of patients used intensive care unit beds, 2.2% required postoperative mechanical ventilation, 9.2% required red blood cell transfusions, and 9.3% were readmitted within 90 days of surgery. An example of a framework for matching hospital demand with elective surgery supply is provided.

Conclusions: Acute care needs after elective surgery in the United States are consistent and predictable. When these data are overlaid with national hospital capacity models, rational decisions regarding matching supply to demand can be achieved to meet changing needs.

Introduction

The COVID-19 pandemic has tested health care capacity worldwide.[1] According to initial reports in the United States, as many as 12% of patients with COVID-19 require acute care hospitalization. Of these, approximately 25% require admission to an intensive care unit (ICU).[2] One way that this demand for acute care capacity is being met is through the perioperative infrastructure with delays in elective surgery.

Our study objective was to describe the extent to which common inpatient elective surgical procedures consume acute and critical care resources. We also sought to provide an example of an initial framework for matching changing demand with corresponding changes in supply created by rational delays in elective surgery.

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