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Cancellation of elective surgery and intensive care unit capacity in New York state: a retrospective cohort analysis.
Anesthesia and Analgesia 2020 June 24
BACKGROUND: In response to the COVID-19 pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear.
METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions), and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included.
RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n=1,232,986/n=12,251,617) and remained stable over a 5 year period from 2011 to 2015. Among n=1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n=165,365), emergent/urgent admissions/trauma surgery (28.0%, n=345,094), and medical admissions (58.6%, n=722,527). Ventilator utilization was seen in 26.3% (n=323,789/n=1,232,986) of all ICU patients of which 6.4% (n=20,652), 32.8% (n=106,186) and 60.8% (n=196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n=2496/n=3566) in New York State.
CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More work is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.
METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions), and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included.
RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n=1,232,986/n=12,251,617) and remained stable over a 5 year period from 2011 to 2015. Among n=1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n=165,365), emergent/urgent admissions/trauma surgery (28.0%, n=345,094), and medical admissions (58.6%, n=722,527). Ventilator utilization was seen in 26.3% (n=323,789/n=1,232,986) of all ICU patients of which 6.4% (n=20,652), 32.8% (n=106,186) and 60.8% (n=196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n=2496/n=3566) in New York State.
CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More work is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.
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