Changes in surgical mortality during COVID-19 pandemic by patients’ race, ethnicity and socioeconomic status among US older adults: a quasi-experimental event study model

• Published in: BMJ open Vol. 14; no. 2; p. e079825
• Main Authors: Blegen, Mariah B, Rook, Jordan M, Jackson, Nicholas J, Maggard-Gibbons, Melinda, Li, Ruixin, Russell, Marcia M, Russell, Tara A, de Virgilio, Christian, Tsugawa, Yusuke
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 15.02.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Aged; Chronic illnesses; COVID-19; Ethnicity; Health insurance; Humans; Medicare; Mortality; Older people; Pandemics; Race; Social Class; Socioeconomic factors; Socioeconomic status; Surgery; Surgical outcomes; United States - epidemiology; United States; United States > US; COVID-19; mortality; surgery
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-079825

ObjectivesTo examine changes in the 30-day surgical mortality rate after common surgical procedures during the COVID-19 pandemic and investigate whether its impact varies by urgency of surgery or patient race, ethnicity and socioeconomic status.DesignWe used a quasi-experimental event study design to examine the effect of the COVID-19 pandemic on surgical mortality rate, using patients who received the same procedure in the prepandemic years (2016–2019) as the control, adjusting for patient characteristics and hospital fixed effects (effectively comparing patients treated at the same hospital). We conducted stratified analyses by procedure urgency, patient race, ethnicity and socioeconomic status (dual-Medicaid status and median household income).SettingAcute care hospitals in the USA.ParticipantsMedicare fee-for-service beneficiaries aged 65–99 years who underwent one of 14 common surgical procedures from 1 January 2016 to 31 December 2020.Main outcome measures30-day postoperative mortality rate.ResultsOur sample included 3 620 689 patients. Surgical mortality was higher during the pandemic, with peak mortality observed in April 2020 (adjusted risk difference (aRD) +0.95 percentage points (pp); 95% CI +0.76 to +1.26 pp; p<0.001) and mortality remained elevated through 2020. The effect of the pandemic on mortality was larger for non-elective (vs elective) procedures (April 2020: aRD +0.44 pp (+0.16 to +0.72 pp); p=0.002 for elective; aRD +1.65 pp (+1.00, +2.30 pp); p<0.001 for non-elective). We found no evidence that the pandemic mortality varied by patients’ race and ethnicity (p for interaction=0.29), or socioeconomic status (p for interaction=0.49).Conclusions30-day surgical mortality during the COVID-19 pandemic peaked in April 2020 and remained elevated until the end of the year. The influence of the pandemic on surgical mortality did not vary by patient race and ethnicity or socioeconomic status, indicating that once patients were able to access care and undergo surgery, surgical mortality was similar across groups.