Highlights
- •Bariatric case volume decreased 84% at MTFs vs 20% in adjacent civilian centers during the initial response to the pandemic.
- •Major colorectal surgical case volume at both MTFs and adjacent civilian facilities was minimally affected by the pandemic.
- •MTF bariatric case volume has been slow to recover with a greater percentage of cases now being done in civilian centers.
Abstract
Introduction
The Military Health System (MHS) is tasked with the dual mission of providing medical
care to beneficiaries while ensuring medical readiness. MHS provides care through
a combination of military treatment facilities (MTF) (“direct care”; DC) & off-base
civilian facilities (“purchased care”; PC). Given recent concerns regarding low surgical
volume at MTFs, we sought to evaluate COVID's impact on elective and non-elective
case volume at MTFs with surgical residencies.
Methods
Retrospective review of 2017–2021 M2 database was performed on Tricare beneficiaries
who underwent bariatric surgery or major colorectal surgery in the DC or PC market
at, or, surrounding MTFs with surgical residencies. Procedures were identified using
ICD-10 procedure codes and Medicare severity-diagnosis related groups. A detailed
analysis was then performed on changes in case volume in the DC and PC markets.
Results
5,698 bariatric and 5,517 major colorectal procedures were performed during the study
period. There was an 84% vs 20% quarterly decrease in elective bariatric surgeries
completed in the DC and PC markets from Q1 to Q2 2020. Pre to post-COVID (Q1 2017
– Q1 2020 vs Q3 2020 – Q4 2021) there was a decrease in the percentage of bariatric
surgeries completed in the DC market (74.1% vs 55.0%, p = 0.001). Meanwhile, major
colorectal surgery quarterly case volume remained unchanged in the DC (137 vs 125,
p = 0.18) and PC (146 v 137, p = 0.13) markets, pre- and post-COVID.
Discussion
Bariatric surgical case volume at MTFs disproportionately decreased during COVID when
compared to the PC market and major colorectal cases. Bariatric case volume has rebounded
in PC markets surpassing pre-COVID levels while DC case volume remains depressed.
Further attention is warranted regarding decreased elective surgical case volume at
MTFs.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
February 2,
2023
Received in revised form:
January 21,
2023
Received:
September 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc.
