For months Adina Perullo has been waiting to have a surgery that could save her life.
Perullo, a 36-year-old mother of two from Levittown, N.Y., planned to have an operation in early April to remove her ovaries to prevent ovarian cancer. About a week before her procedure, Perullo was told by her doctor that North Shore University Medical Center in Manhasset, N.Y. had postponed all elective surgeries to divert resources to the pandemic. All across New York, hospitals ceased nonurgent surgeries to comply with a March 23 order from Gov. Andrew Cuomo.
Some patients needing operations deemed safe to postpone, such as those to address heart problems, cancer or hernias, have been waiting months for treatment.
Last year Perullo underwent a double mastectomy after doctors found she had stage-two breast cancer and testing showed she had a mutation in the BRCA-2 gene that puts people at higher risk for several cancers.
"I've seen it go from nothing to something virtually overnight," Perullo said. "That's where my fear lies."
The state Department of Health granted New York City hospitals permission to resume nonurgent surgeries June 8—Long Island and Westchester facilities got the green light in late May—but the busiest facilities have thousands of procedures to schedule. Perullo is working with her doctor to find a date for surgery.
Hospitals had been able to perform medically necessary surgeries with wide discretion as to which should be performed. That discretion was needed to avoid adverse effects. A study from the Annals of Oncology, published online in May, found evidence that modest delays in surgery could significantly affect a patient's chance of survival. It noted the need for "rapid attention to any backlog already accrued.
Hospitals were balancing performing surgeries with preserving staff and supplies for COVID-19 care. Every patient undergoing and recovering from surgery would lead to the higher use of protective equipment, which was in short supply, and a need for an operating-room ventilator.
Manhattan's Hospital for Special Surgery, known for its prolific knee, hip and other joint surgeries, said in late May that it had a backlog of about 7,000 patients.
At the peak of the crisis, New York's operating rooms were mostly dormant. HSS dropped to as low as 8% of its total operating-room capacity during that period. It performed about 35,000 surgeries last year.
Louis Shapiro, its CEO, said the orthopedic hospital created a system for classifying elective surgeries in mid-March ahead of the executive order to halt procedures.
After first working to accept non-COVID-19 patients from other hospitals, HSS made the decision in April to admit positive patients as well, converting its operating rooms into intensive care units.
"These are patients who were canceled for surgery back in March, and what may have been elective then is no longer elective because their condition has deteriorated," Shapiro said. "Thousands of patients we canceled months ago started to come back slowly."
As HSS opens up more of its operating rooms, the hospital has needed to thoroughly disinfect areas that served as care sites for COVID-19 patients and replace the anesthesia machines, which had been converted into makeshift ventilators for critically ill patients.
All patients must test negative for the virus ahead of their operation.
Finance factor
The drop in surgeries also led to a financial hit to hospitals that rely on that revenue, particularly from orthopedic and cardiac procedures, to stay solvent.
Elective hospital admissions can make up 30% or more of a hospital's revenue, according to an analysis by researchers at Weill Cornell Medicine in the medical journal JAMA.
The changes hospitals made to elective surgeries, "while needed to respond to the COVID-19 pandemic, potentially threaten the financial viability of hospitals, especially those with preexisting financial challenges and those heavily reliant on revenue from outpatient and elective services," the authors wrote.
The federal Coronavirus Aid, Relief and Economic Security Act included $175 billion in funding for hospitals and other facilities to offset the costs of caring for COVID-19 and losing revenue from postponing surgeries. But more funding targeted toward smaller and independent hospitals may be needed as those facilities typically have less financial liquidity.
Its unclear whether pent-up demand for treatment will lead to higher revenue for health systems.
Several city health systems including Northwell Health and New York–Presbyterian, reported losses of more than $120 million in the first quarter of the year, as they spent more to prepare for COVID-19 while canceling procedures in the last two weeks of March.
Patients could continue to put off some less time-sensitive procedures, especially as the number of New Yorkers with job-based insurance fell in recent months.
Northwell Health saw its surgery volume return in waves as its Long Island and Westchester hospitals received permission to schedule nonurgent procedures weeks ahead of its city hospitals.
The health system worked to ensure it could accommodate social distancing in waiting areas, Michael Dowling, CEO of Northwell, said.
"Recovery, as people call it, is in many ways more difficult than managing the crisis itself because we have to come back in a different way and make sure when we bring back surgery and other procedures, we do it safely," Dowling said. "The world is going to be quite different in every single medical facility going forward."
"Hospitals resuscitate thousands of delayed elective surgeries" originally appeared in Crain's New York Business.
