DataSheet_1_Changes in Urologic Operative Practice at the Beginning of the COVID-19 Pandemic in a Large, National Cohort.docx

ObjectiveTo analyze population-level changes in operative practice since the onset of the COVID-19 pandemic to contextualize observations made by individual practices and optimize future responses.
Materials and MethodsThis US retrospective analysis used the Premier Perspectives Database. We investigated changes in operative volume through March 2020. Baseline operative volume for urologic surgery was calculated using data from the preceding 12 months and compared on a total and by procedure basis. Multivariable linear regression was used to identify hospital-level predictors of change in response to the pandemic.
ResultsAt baseline, we captured 23,788 urologic procedural encounters per month as compared with 19,071 during March 2020– a 19.9% decrease. Urologic oncology-related cases were relatively preserved as compared to others (average change in March 2020: +1.1% versus -32.2%). Northeastern (β = -5.66, 95% confidence interval [CI]: -10.2 to -1.18, p = 0.013) and Midwestern hospitals (β = -4.17, 95% CI: -7.89 to -0.45, p = 0.027; both with South as reference region), and those with an increasing percentage of patients insured by Medicaid (β= -0.17 per percentage point, 95% CI: -0.33 to -0.01, p = 0.04) experienced a significantly larger decrease in volume.
ConclusionsThere was a 20% decline in urologic operative volume in March 2020, compared with baseline, that preferentially affected hospitals serving Medicaid patients, and those in Northeast and Midwest. In the face of varying mandates on elective surgery, widespread declines in operative volume may also represent hesitancy on behalf of patients to interface with healthcare during the pandemic.

研究目的：分析自新型冠状病毒肺炎（COVID-19）疫情暴发以来，手术实践的人群层面变化，以厘清个体临床实践的观察结果并优化未来疫情应对策略。
材料与方法：本研究为美国地区的回顾性分析，采用Premier Perspectives数据库。我们针对截至2020年3月的手术量变化展开调研。以疫情暴发前12个月的数据作为基线，计算泌尿外科手术的基线手术量，并从总体及单手术类型层面进行对比。采用多变量线性回归分析，识别医院层面影响疫情应对手术量变化的预测因素。
研究结果：基线状态下，每月泌尿外科手术接诊量为23788例，而2020年3月期间为19071例，降幅达19.9%。与其他类型手术相比，泌尿肿瘤相关病例数量相对保持稳定（2020年3月平均变化率为+1.1%，其余类型为-32.2%）。以南部地区医院作为参照组，东北部（β=-5.66，95%置信区间[CI]：-10.2~-1.18，P=0.013）与中西部地区医院（β=-4.17，95%CI：-7.89~-0.45，P=0.027），以及患者中医疗补助保险（Medicaid）参保占比升高的医院，其手术量降幅更为显著（β=-0.17/百分点，95%CI：-0.33~-0.01，P=0.04）。
研究结论：与基线水平相比，2020年3月泌尿外科手术量下降了20%，该降幅对收治Medicaid参保患者较多的医院以及东北部、中西部地区医院影响更为突出。尽管针对择期手术存在各不相同的强制管控指令，但手术量的普遍下降也可能反映出疫情期间患者对就医交互存在抵触情绪。