4 Common Surgeries Shifted to Outpatient During COVID-19

The COVID-19 pandemic prompted greater uptake of outpatient surgery for four commonly scheduled general surgery operations, according to a new study in JAMA Network Open.

Hospitals in the American College of Surgeons’ National Surgical Quality Improvement Program performed significantly more outpatient surgeries for mastectomy for breast cancer, thyroid lobectomy, minimally invasive ventral hernia repair, and parathyroidectomy from 2016 to 2020, the retrospective cohort study found.

Researchers from the Mayo Clinic deemed the increases in outpatient surgery rates for the four procedures significant, growing by 10 percent or more during the period.

Outpatient surgery rates also increased across six other commonly scheduled general surgery operations, including total thyroidectomy, minimally invasive adrenalectomy, minimally invasive fundoplication, and breast lumpectomy. However, the rates of increase did not exceed 10 percent from baseline, researchers said in the study.

Meanwhile, they observed small but significant decreases in outpatient surgery rates from 2016 through 2020 for open inguinal hernia repair (89.6 percent to 89.1 percent) and open umbilical hernia repair (92.6 percent to 92.1 percent).

The COVID-19 pandemic drove a large increase in outpatient cases in 2020 as hospitals had to conserve resources and bed capacity during the COVID-19 pandemic while maintaining surgical throughput, researchers explainted in the study.

However, the pandemic did not lead to a “meaningful increase” in the number of outpatient surgical procedures performed in hospitals versus pre-pandemic levels for most procedures, researchers concluded.

“For most procedures, a statistically significant increase in the number of outpatient cases was observed over the last 5 years, with an accelerated transition toward same-day discharge seen after COVID-19 was declared a global pandemic in 2020,” they wrote in the study.

Value-based care and other trends have influenced the shift from inpatient to outpatient cases since before the global spread of COVID-19. In fact, the adoption of outpatient surgery has been widespread across many surgical subspecialties, with research backing the feasibility and safety of outpatient procedures for colectomies, inguinal hernia repairs, and adrenalectomies, the study stated.

Hospital and health system executives expect the shift toward outpatient care to continue, with 95 percent of executives responding to a recent Healthcare Financial Management Association (HFMA) and Guidehouse Center for Health Insights survey saying they anticipate higher volumes in 2023.

Shifting cases from inpatient to outpatient settings has many benefits, including a lower risk of exposure to nosocomial infections, cost savings, and increased patient satisfaction due to the ability to recover at home.

Researchers from Mayo Clinic said potential barriers might be preventing greater uptake of outpatient surgery rates across many common surgeries, including minimally invasive cholecystectomy, fundoplication, and colectomy, all of which are considered safe when performed on an outpatient basis in appropriately selected patients.

“Further studies to determine potential complications associated with this approach and the changes in practices that occurred during subsequent surges in COVID cases in 2021 are warranted,” the study concluded.