General Surgery Procedures during COVID-19

This cohort study was determined to be exempt from review and informed consent by the institutional review board of the Mayo Clinic, Rochester, Minnesota, owing to the use of deidentified data. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Adult patients (ie, patients aged ≥18 years) who underwent 1 of 16 commonly scheduled general surgery operations (minimally invasive colectomy for cancer, minimally invasive colectomy for benign disease, lumpectomy for breast cancer, mastectomy for breast cancer, minimally invasive adrenalectomy, thyroid lobectomy, total thyroidectomy, parathyroidectomy, minimally invasive inguinal hernia repair, open inguinal hernia repair, minimally invasive ventral hernia repair, open umbilical hernia repair, minimally invasive sleeve gastrectomy, minimally invasive gastric bypass, minimally invasive cholecystectomy, and minimally invasive fundoplication) from January 1, 2016, to December 31, 2019 (before COVID-19), and January 1 to December 31, 2020 (during the COVID-19 pandemic), were identified in the ACS-NSQIP database using Current Procedural Terminology codes (eTable 1 in Supplement 1). These 16 procedures were selected as they represented the most frequently performed general surgery operations identified by the surgical specialty variable within the ACS-NSQIP database and consisted of a variety of procedures. To limit case-mix variation over time, each procedure group was limited to a consistent set of diagnosis codes specific to that procedure, based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification, or the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (eTable 1 in Supplement 1). Patients with severe preoperative comorbidities that were likely to necessitate an inpatient stay (preoperative ventilator dependence, sepsis, septic shock, systemic inflammatory response syndrome, open and/or infected wound, acute renal failure, >4 U of red blood cell transfused within 72 hours prior to procedure, American Society of Anesthesiologists [ASA] class V, and disseminated cancer), and urgent or emergent operations were excluded from the analysis. Details regarding the number of hospitals participating in the ACS-NSQIP, the total number of cases submitted, the process for data collection, definitions of outcome variables, and procedures for ensuring the reliability of the data are described in the ACS-NSQIP Participant Use Data File user guide.¹⁰