eP674 - Changes in Colon Cancer Colectomy Volumes and Inpatient Resource Utilization Through the COVID-19 Pandemic: A Medicare Analysis Through 2021

Purpose/Background: The COVID-19 pandemic caused sudden declines in surgical procedures as health systems sought to preserve limited resources and minimize infection transmission. Initial guidance called for postponement of cancer screenings as well as delay of non-urgent surgical procedures. How the onset of the pandemic affected surgical care of colon cancer remains unknown. Among Medicare patients, we sought to measure changes in colectomy volumes as well as changes in patient and hospitalization characteristics during the pandemic compared to immediately pre-pandemic. We hypothesized that colectomy volumes decreased during the pandemic but average hospital resource utilization per patient increased. We also hypothesized that patient demographics remained stable but that, on average, patients were more comorbid and their care more acute.Methods/Interventions: In this retrospective cohort study, we used Medicare data of ICD-10 and CPT codes to identify patients who underwent colectomy for colon cancer from a 5% sample file. The primary exposure was the COVID-19 pandemic, with the pre-pandemic period defined as Q1 2018 through Q1 2020, and the pandemic period defined as Q2 2020 through Q4 2021. The primary outcome was colectomy volume, analyzed at quarterly intervals. Multivariate analysis was used to compare variables between the pre-pandemic and pandemic periods including race, sex, age, Medicare-Medicaid dual eligibility, Elixhauser readmission and mortality indices, length of hospital stay, total Medicare payment amount, diagnosis related groups (DRGs), admission type (elective vs emergent), proportion of laparoscopic versus open surgeries, and proportion of patients with an ostomy matured. A p value of < 0.05 was considered significant. STATA version 17.0.127 was used for analysis.Results/Outcomes: We identified 4,278 patients who underwent colectomy for colon cancer during the study period (Jan 2018 – Dec 2021). Colectomy volumes fell by 36.8% in Q2 of 2020, compared to Q2 of 2019 (Figure 1). In Q4 of 2021, colectomy volumes fell again, this time by 38.5% compared to Q4 2019. Mean colectomy volume per quarter was significantly lower during the pandemic than pre-pandemic (229.71 vs 296.66, p < 0.001). Patient age, race, sex, and dual eligibility did not differ significantly throughout the study period. Elixhauser readmission indices and distribution of DRGs demonstrated higher comorbidity levels during the pandemic than pre-pandemic, which coincided with significantly higher Medicare payments. Average payment for a hospitalization during which a colectomy was performed for colon cancer increased by almost $2,000 (9%) during the pandemic compared to pre-pandemic, which amounts to $63,708,960 in added costs from pandemic onset through the end of 2021.Conclusion/

Discussion: The pandemic onset brought major declines in the numbers of colectomies performed for colon cancer in the Medicare population, which remained below baseline volumes at the end of 2021. While patient demographics largely remained unchanged, patients undergoing colectomy for colon cancer during the pandemic were sicker, and their care was more complex and costly. These results and further study of the long-term effects of these changes on colon cancer survival may help inform policy and resource allocation in future situations toward maintaining surgical care for colon cancer patients.Figure 1. Volume of colectomies for colon cancer, by quarter.