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Surgery

Defining Essential Surgery in the US During the COVID-19 Pandemic Response

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: October 19, 2022

Research Letter

Article Information and Disclosures

Aviva S. Mattingly, MD¹;

Hyrum S. Eddington, BS²;

Liam Rose, PhD^2,3;

Arden M. Morris, MD, MPH^2,4,5;

Amber W. Trickey, PhD, MS, CPH²;

Mark R. Cullen, MD⁶;

Sherry M. Wren, MD^2,4,5

Author Affiliations

¹Department of Surgery, Massachusetts General Hospital, Boston
²Stanford-Surgery Policy Improvement Research & Education Center, Stanford, California
³Economics Resource Center, Department of Veterans Affairs, Palo Alto, California
⁴Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
⁵Department of Surgery, Stanford University School of Medicine, Stanford, California
⁶Center for Population Health Sciences, Stanford Medicine, Stanford, California

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The World Bank Disease Control Priorities¹ defined 44 essential surgical procedures (ESPs) as a starting point for health care systems in low- and middle-income countries (LMICs) to avert substantial death and/or disability. This list has never been expanded for nations with more advanced health care systems. The initial US COVID-19 pandemic response to curtail elective surgery offered an opportunity to evaluate and modify the list of essential procedures applicable to the US health care system. We aimed to compare ESPs with other surgical procedures performed during the COVID-19 shutdown in April 2020.

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Article Information

Accepted for Publication: July 7, 2022.

Published Online: October 19, 2022. doi:10.1001/jamasurg.2022.3944

Corresponding Author: Sherry M. Wren, MD, Department of Surgery, Stanford University School of Medicine, G112, 3801 Miranda Ave, Palo Alto, CA 94304 (swren@stanford.edu).

Author Contributions: Dr Rose had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mattingly, Wren.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Eddington, Rose, Trickey.

Obtained funding: Wren.

Administrative, technical, or material support: Mattingly, Wren.

Supervision: Cullen, Wren.

Conflict of Interest Disclosures: Dr Rose reported receiving grants from the Department of Veterans Affairs during the conduct of the study. Dr Cullen reported receiving personal fees from Datavant, Inc, Pfizer, Manatt, and the Bill & Melinda Gates Foundation outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by a seed grant from the Stanford University School of Medicine Department of Surgery (Dr Wren).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The opinions expressed in this article are those of the authors and do not necessarily represent the views of Change Healthcare.

References

Debas HT , Donkor P , Gawande A , Jamison DT , Kruk ME , Mock CN , eds. Disease Control Priorities, Third Edition (Volume 1): Essential Surgery. World Bank; 2015.

Mattingly AS , Rose L , Eddington HS , et al. Trends in US surgical procedures and health care system response to policies curtailing elective surgical operations during the COVID-19 pandemic. JAMA Netw Open. 2021;4(12):e2138038. doi:10.1001/jamanetworkopen.2021.38038 PubMed Google Scholar Crossref

Centers for Medicare & Medicaid Services. Non-emergent, elective medical services, and treatment recommendations. April 7, 2020. Accessed March 20, 2021. https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf

Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project: Clinical Classifications Software for Services and Procedures, Version 2020.1. Accessed May 14, 2021. https://www.hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp

NSW Government. Elective surgery access. January 12, 2022. Accessed January 20, 2022. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2022_001.pdf

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.