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A1019
October 03, 2020
10/3/2020 12:00:00 PM - 10/3/2020 1:00:00 PM
Room Virtual
Strategic Icu Capacity Reallocation In New York State During The Covid-19 Pandemic: A Descriptive Explorative Projections
Haoyan Zhong, M.A., Jashvant Poeran, M.D.,Ph.D., Lauren Wilson, M.P.H., Jiabin Liu, M.D.,Ph.D., Stavros G. Memtsoudis, M.D.,Ph.D.
Hospital for Special Surgery, New York, New York, United States
Disclosures: H. Zhong: None. J. Poeran: None. L. Wilson: None. J. Liu: None. S.G. Memtsoudis: None.
Background: The COVID-19 outbreak in New York State has put substantial strain on critical care resources such as intensive care unit (ICU) beds and mechanical ventilation capacity. In response, state authorities issued a stay-at-home order and called for the suspension of all elective surgeries in mid-March of 2020. While the latter was enforced in order to free up hospital (including ICU) beds, a stay-at-home order was directly aimed at curtailing exposure to infections. However, an additional consequence of stay-at-home orders has been a reduction in (traffic) accidents1 which may also indirectly affect ICU utilization. Moreover, New York State surveillance data2 suggests a decrease in non-COVID-19-related ED visits, trauma, and inpatient admission, thus further benefiting ICU capacity.

Method: After IRB approval (IRB 2016-436) patient-level data was extracted from the New York SPARCS dataset (2011-2015). We included all adult and pediatric ICU admissions; excluded were cases classified as ‘newborn’ or ‘neonatal’ ICU admissions, those with missing date of admission, and patients with HIV infection or who had an abortion (due to withholding of data on these patients by New York State). ICU and mechanical ventilation were defined using ICU-specific billing codes3 and international classification of diseases, ninth edition (ICD-9) codes 93.9x and 96.7x. Mechanical ventilation was further classified into invasive/non-invasive and duration (>=96 hours and <96 hours consecutive invasive ventilation). Descriptions of ICU utilization and mechanical ventilation stratified by 1) elective surgery, emergent/urgent/trauma surgery, and medical admissions, and by 2) geographic location (New York metropolitan region compared to the rest of New York State) are presented as absolute numbers and percentages.

Results: The adult/pediatric ICU capacity in New York State is 3,566, which served an average of 246,597 annual admissions; sources of ICU admission include 13.4% related to elective surgery, 28.0% related to emergent/urgent admissions/trauma surgery, and 58.6% related to medical admission. Among all ICU admissions, 323,037 (26.2%) patients required ventilation. The majority (60.8%) of ventilated patients were medical ICU admissions. Emergent/urgent/trauma surgery-related ICU admissions were most likely (56.9%) to require prolonged (i.e. >= 96 hours) of invasive ventilation. New York City holds the majority of the ICU bed capacity (68.2%) in New York State.

Conclusions: Suspension of elective surgeries in response to the COVID-19 pandemic may not decrease ICU utilization as significantly as the reduction of emergent/urgent/trauma ICU admissions, which might decrease secondary to stay-at-home order. It is also noteworthy that only 26.2% of all ICU patients required ventilator support. Strategic reallocation of patients without ventilator requirements might be able to mobilize more essential resources in caring for COVID-19 patients. While New York State may have reached the apex of the pandemic at the time of publication, these results may inform policies in future outbreaks.

References:1.Road Ecology Center, UC Davis. Special Report: Impact of COVID19 on California Traffic Accidents. Online: https://roadecology.ucdavis.edu/files/content/projects/COVID_CHIPs_Impacts.pdf (accessed 04-11-2020).

2.NYC Health Data. EpiQuery. Syndromic Surveillance. Online: https://a816-health.nyc.gov/hdi/epiquery/ (accessed 04-11-2020).

3.Barrett ML, Smith MW, Elixhauser A, Honigman LS, Pines JM. Utilization of Intensive Care Services, 2011: Statistical Brief #185. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD)2006.

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