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Covid-19: US hospitals continued to perform unnecessary surgeries during pandemic

BMJ 2022; 377 doi: (Published 19 May 2022) Cite this as: BMJ 2022;377:o1254
  1. Janice Hopkins Tanne
  1. New York

US hospitals continued to perform eight overused and unnecessary surgical procedures for older patients during the first year of the pandemic, a study1 has shown.

Cardiologist Vikas Saini, president of the Lown Institute in Needham, Massachusetts, which carried out the research, said, “You couldn’t go into your local coffee shop during early days of the pandemic but hospitals brought people in for all kinds of unnecessary procedures. The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”

The non-profit institute studies ways to avoid unnecessary care. It was founded by the late Bernard Lown, co-winner of the 1985 Nobel peace prize, Harvard cardiologist, and developer of the direct current defibrillator and the cardioverter for correcting heart dysrhythmias.

“Overuse or low value care refers to medical services that offer little or no clinical benefit or may lead to harm rather than benefit,” said Saini at a press briefing. In a previous study2 the institute had shown overuse was common. Shannon Brownlee, special assistant to Saini, said, “Overuse is wasteful and exposes patients to harms they never would have experienced if they had not received that unnecessary procedure or hospital admission. About one in 100 low value procedures results in a hospital acquired infection or some other patient safety event in the hospital. Another common type of harm from overuse is the follow up tests and procedures, known as cascade events.”

The institute looked at eight low value procedures: stents for stable coronary disease, vertebroplasty for osteoporosis, hysterectomy for benign disease, spinal fusion for back pain, inferior vena cava filter, carotid endarterectomy, and knee arthroscopy.

The study used claims data from Medicare, government health insurance for people over 65, from January to December 2020.

From March to December, when the pandemic was at its height and no vaccines were available, hospitals performed 106 474 low value procedures. Stents for stable coronary artery disease were the most common procedure, with 45 176 performed. The institute said stents can cause blood clots leading to a stroke or heart attack, injury to the heart arteries, infection at the catheter site, allergic reaction to the dye or contrast used, and kidney damage from the dye or contrast, as well as hospital acquired infections.

Among the general hospitals placing the most stents were NYU Langone Medical Center, St Francis Hospital, and Mount Sinai Hospital in the New York City area, and Scripps Memorial Hospital and Cedars-Sinai Medical Center in southern California. Of the 20 hospitals on the US News and World Report “honor roll”—a popular rating by the magazine—all were rated above the national average.

During the pandemic there were also 16 553 vertebroplasties for osteoporosis carried out, 14 455 hysterectomies for benign disease, 13 541 spinal fusions for back pain, 9595 insertions of inferior vena cava filters, 3667 carotid endarterectomies, 1891 renal stents, and 1596 knee arthroscopies.

A previous study of overuse by the institute found that hospitals in the north east and the Pacific north west were best at avoiding overuse, while hospitals in southern states were more likely to deliver low value services.3

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