Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns

Mehta, Aashna; Awuah, Wireko Andrew; Ng, Jyi Cheng; Kundu, Mrinmoy; Yarlagadda, Rohan; Sen, Meghdeep; Nansubuga, Esther Patience; Abdul‐Rahman, Toufik; Hasan, Mohammad Mehedi

doi:10.1016/j.amsu.2022.104395

Cited by 29 publications

(21 citation statements)

References 52 publications

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“…A study by Aashna et al [ 49 ], focused on the changes in the operational guidelines over the duration of the pandemic and how these alterations continue to affect the services to patients and the patient experience as COVID-19 eased and progressively converted into an endemic entity. The healthcare system needed to prepare for a sizable increase in surgeries as the COVID-19 pandemic wound down because the majority of elective procedures were shifted to a later time.…”

Section: Resultsmentioning

confidence: 99%

Surgical Protocols before and after COVID-19—A Narrative Review

et al. 2023

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The COVID-19 epidemic has affected not only people’s daily lives but also the working methods of clinicians, surgical procedures, open/minimally invasive procedures, operating room management, patient and healthcare worker safety, education and training. The main objective of this study was to review selected articles and determine the changes in the general surgery protocols/procedures before and after the emergence of the COVID-19 pandemic. The literature was carried out in PubMed-Medline, Cochrane Library, Embase, Scopus and Google Scholar. The terms utilised for the searches were “SARS-CoV-2”, “Surgery”, “COVID-19”, “Surgical protocol”, “Surgical recommendations” and “before and after”. A total of 236 studies were identified, out of which 41 studies were included for data extraction. Significant changes in all the articles were observed with respect to the surgeries done before, during and after the COVID-19 pandemic. Specifically, the number of elective surgeries were considerably fewer in comparison to the pre-pandemic period. Since the COVID-19 pandemic started, hospitals all throughout the world have conducted significantly fewer procedures, particularly elective/non-urgent surgeries.

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Section: Resultsmentioning

confidence: 99%

Surgical Protocols before and after COVID-19—A Narrative Review

et al. 2023

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“…With the ongoing pandemic, conditions returned to normal [ 21 ]. As the pandemic progressed, delayed elective procedures that had accumulated, the so-called surgical back-log, had to be performed nonetheless, and so the numbers of surgeries normalized again [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Covid-19 pandemic on the performance of machine learning algorithms for predicting perioperative mortality

Andonov

Ulm

Graeßner

et al. 2023

BMC Med Inform Decis Mak

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Background Machine-learning models are susceptible to external influences which can result in performance deterioration. The aim of our study was to elucidate the impact of a sudden shift in covariates, like the one caused by the Covid-19 pandemic, on model performance. Methods After ethical approval and registration in Clinical Trials (NCT04092933, initial release 17/09/2019), we developed different models for the prediction of perioperative mortality based on preoperative data: one for the pre-pandemic data period until March 2020, one including data before the pandemic and from the first wave until May 2020, and one that covers the complete period before and during the pandemic until October 2021. We applied XGBoost as well as a Deep Learning neural network (DL). Performance metrics of each model during the different pandemic phases were determined, and XGBoost models were analysed for changes in feature importance. Results XGBoost and DL provided similar performance on the pre-pandemic data with respect to area under receiver operating characteristic (AUROC, 0.951 vs. 0.942) and area under precision-recall curve (AUPR, 0.144 vs. 0.187). Validation in patient cohorts of the different pandemic waves showed high fluctuations in performance from both AUROC and AUPR for DL, whereas the XGBoost models seemed more stable. Change in variable frequencies with onset of the pandemic were visible in age, ASA score, and the higher proportion of emergency operations, among others. Age consistently showed the highest information gain. Models based on pre-pandemic data performed worse during the first pandemic wave (AUROC 0.914 for XGBoost and DL) whereas models augmented with data from the first wave lacked performance after the first wave (AUROC 0.907 for XGBoost and 0.747 for DL). The deterioration was also visible in AUPR, which worsened by over 50% in both XGBoost and DL in the first phase after re-training. Conclusions A sudden shift in data impacts model performance. Re-training the model with updated data may cause degradation in predictive accuracy if the changes are only transient. Too early re-training should therefore be avoided, and close model surveillance is necessary.

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“…The growing number of laparoscopic procedures in the study is a positive trend for Romania, as it offers patients a less invasive and potentially more effective option for groin hernia repair. Laparoscopic repair has been shown to have lower rates of postoperative pain, shorter hospital stays, faster recovery times, and thus to be less expensive than open-mesh surgery [ 25 , 26 , 27 ]. A 2015 Romanian study found laparoscopic GHRS to have shorter postoperative care periods by 1.8 days [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Groin Hernia Repair during the COVID-19 Pandemic—A Romanian Nationwide Analysis

et al. 2023

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Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusion: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

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Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns

Cited by 29 publications

References 52 publications

Surgical Protocols before and after COVID-19—A Narrative Review

Surgical Protocols before and after COVID-19—A Narrative Review

Impact of the Covid-19 pandemic on the performance of machine learning algorithms for predicting perioperative mortality

Groin Hernia Repair during the COVID-19 Pandemic—A Romanian Nationwide Analysis

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