Impact of COVID on surgical case volume at military treatment facilities with surgical residencies - 02/05/23

Doi : 10.1016/j.amjsurg.2023.02.003

James Williams ^a,^⁎ , Andrew Francis ^a, Beau Prey ^a, Jeffrey Conner ^a, Daniel Lammers ^a, Pamela M. Choi ^b, Diego Vicente ^b, Jason Bingham ^a, John McClellan ^a
^a Madigan Army Medical Center, Tacoma, WA, USA
^b Naval Medical Center San Diego, San Diego, CA, USA

^∗Corresponding author. 9040A Jackson Ave, Tacoma, WA, 98431, USA.9040A Jackson AveTacomaWA98431USA

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Abstract

Introduction

The Military Health System (MHS) is tasked with the dual mission of providing medical care to beneficiaries while ensuring medical readiness. MHS provides care through a combination of military treatment facilities (MTF) (“direct care”; DC) & off-base civilian facilities (“purchased care”; PC). Given recent concerns regarding low surgical volume at MTFs, we sought to evaluate COVID's impact on elective and non-elective case volume at MTFs with surgical residencies.

Methods

Retrospective review of 2017–2021 M2 database was performed on Tricare beneficiaries who underwent bariatric surgery or major colorectal surgery in the DC or PC market at, or, surrounding MTFs with surgical residencies. Procedures were identified using ICD-10 procedure codes and Medicare severity-diagnosis related groups. A detailed analysis was then performed on changes in case volume in the DC and PC markets.

Results

5,698 bariatric and 5,517 major colorectal procedures were performed during the study period. There was an 84% vs 20% quarterly decrease in elective bariatric surgeries completed in the DC and PC markets from Q1 to Q2 2020. Pre to post-COVID (Q1 2017 – Q1 2020 vs Q3 2020 – Q4 2021) there was a decrease in the percentage of bariatric surgeries completed in the DC market (74.1% vs 55.0%, p = 0.001). Meanwhile, major colorectal surgery quarterly case volume remained unchanged in the DC (137 vs 125, p = 0.18) and PC (146 v 137, p = 0.13) markets, pre- and post-COVID.

Discussion

Bariatric surgical case volume at MTFs disproportionately decreased during COVID when compared to the PC market and major colorectal cases. Bariatric case volume has rebounded in PC markets surpassing pre-COVID levels while DC case volume remains depressed. Further attention is warranted regarding decreased elective surgical case volume at MTFs.

Le texte complet de cet article est disponible en PDF.

Highlights

•	Bariatric case volume decreased 84% at MTFs vs 20% in adjacent civilian centers during the initial response to the pandemic.
•	Major colorectal surgical case volume at both MTFs and adjacent civilian facilities was minimally affected by the pandemic.
•	MTF bariatric case volume has been slow to recover with a greater percentage of cases now being done in civilian centers.

Le texte complet de cet article est disponible en PDF.

Keywords : MIS/Bariatric/Hernia, Colorectal surgery, Military surgery, COVID