Medical Student Yale New Haven Hospital New Haven, CT
Award: Presidential Poster Award
Ysabel Ilagan-Ying, MD1, Mariana N. Almeida, BA2, Arianna Kahler-Quesada, BS2, Lee Ying, MD, PhD1, Albert Do, MD, MPH2, Michelle L. Hughes, MD2, Kenneth H. Hung, MD, MS2; 1Yale New Haven Hospital, New Haven, CT; 2Yale School of Medicine, New Haven, CT
Introduction: The COVID-19 pandemic has impacted the way care is provided and led to healthcare systems restructuring service lines for patients with COVID-19. The impact of this on inpatient endoscopy is not yet known. We studied patterns of inpatient gastrointestinal (GI) procedures to evaluate the effect of the COVID-19 pandemic on inpatient endoscopy utilization patterns and patient characteristics. Methods: We retrospectively reviewed all inpatient endoscopic procedures performed on patients 18 years or older at a large academic medical center and its affiliate hospital from 3/1/2019-4/30/2019 (control) and 3/1/2020-4/30/2020 (COVID-19). Patient demographics were recorded, and zip codes referenced with census data for population statistics. Cases were categorized by indication and urgency. Demographic and procedural characteristics were then compared between COVID-19 and control groups. Results: There were 784 patients who underwent 1,032 procedures. Compared to 2019, inpatient endoscopy volume decreased from 611 to 421, with an increase in proportion of urgent and traveling/outside of endoscopy suite procedures (Fig. 1). There was no difference in age, sex, or median income. A decreased proportion of Black patients underwent procedures, 20% in 2019 vs.13.7% in 2020 (p=0.02). There was no difference in procedure types, but an increased proportion of procedures conducted outside the endoscopy suite in 2020 (Table 1). Indications for urgent procedures differed in distribution in 2020, with a decreased proportion of procedures for GI bleeding and an increased proportion of procedures for biliary obstruction (p=0.003). Patients undergoing emergent procedures in 2020 were significantly younger than patients undergoing urgent procedures when compared to 2019 (p=0.001) (Fig. 2). Discussion: During the peak of COVID-19, decreased volumes in inpatient GI procedures were observed with changing proportions of urgent and traveling cases. The decline in the proportion of Black patients undergoing endoscopic interventions in 2020 suggest a possible disparity in access to endoscopy or hesitancy towards health care utilization. Additionally, the average age of patients receiving emergent procedures were significantly younger during COVID-19, suggesting that older patients who need emergent procedures may not be receiving them. Further study is needed to understand the effects of the COVID-19 era on patient care, access, and health services-related outcomes.
Table 1. Characteristics of Patients and Inpatient Gastrointestinal Procedures in 2019 (Control) Compared to 2020 (COVID-19)
Figure 1. Distribution of Inpatient Gastrointestinal Procedures by Urgency Status (Emergent, Urgent, and Non-Urgent) in 2019 (Control) Compared to 2020 (COVID-19)
Figure 2. Average Age of Patients Undergoing Urgent and Emergent Inpatient Gastrointestinal Procedures in 2019 (Control) Compared to 2020 (COVID-19)
Disclosures: Ysabel Ilagan-Ying indicated no relevant financial relationships. Mariana Almeida indicated no relevant financial relationships. Arianna Kahler-Quesada indicated no relevant financial relationships. Lee Ying indicated no relevant financial relationships. Albert Do indicated no relevant financial relationships. Michelle Hughes indicated no relevant financial relationships. Kenneth Hung indicated no relevant financial relationships.