Background To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital revenue and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence. Methods A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using Institute for Health Metrics and Evaluation models. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age estimated the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries. Results Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 160 to 130%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross revenue per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue. Conclusions Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross revenue when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue. In these estimates, adopting universal masking would help to avoid overcapacity in all states.

Background: To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital earnings and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence. Methods: A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using a generalized Richards model. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age were used to estimate the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries. Results: Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 340% to 270%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross earnings per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue. Conclusions: Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross earnings when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue.

A powerful Automated Trinocular Stereo Imaging System (ATSIS) is used to remotely measure waves interacting with three distinct ice types: brash, frazil, and pancake. ATSIS is improved with a phaseonly correlation matching algorithm and parallel computation to provide high spatial and temporal resolution 3-D profiles of the water/ice surface, from which the wavelength, frequency, and energy flux are calculated. Alongshore spatial frequency distributions show that pancake and frazil ices differentially attenuate at a greater rate for higher-frequency waves, causing a decrease in mean frequency. In contrast, wave propagation through brash ice causes a rapid increase in the dominant wave frequency, which may be caused by nonlinear energy transfer to higher frequencies due to collisions between the brash ice particles. Consistent to the results in frequency, the wavelengths in pancake and frazil ices increase but decrease in brash ice. The total wave energy fluxes decrease exponentially in both pancake and frazil ice, whereas the overall energy flux remain constant in the brash ice due to thin layer thickness. The spatial energy flux distributions also reveal that wave reflection occurs at the boundary of each ice layer, with reflection coefficient decaying exponentially away from the ice interface. Reflection is the strongest at the pancake/ice-free and frazil/brash interfaces and the weakest at the brash/ice-free interface. These high resolution observations measured by ATSIS demonstrate the spatially variable nature of waves propagating through ice.

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