Trends in Colon Cancer Colectomy Volume and Inpatient Costs, 2018-2023: A Medicare Analysis.

Overview

abstract

INTRODUCTION: Colon cancer is the fourth most common cancer in the United States. With 5 years since the pandemic onset, data are just maturing about the longer term effect of the coronavirus disease 2019 (COVID-19) pandemic on health services and outcomes-we evaluate here the long-term effects on colectomy volumes and resource utilization. METHODS: Cohort study-5% Medicare sample (January 01, 2018-July 31, 2023) of patients with colon cancer who underwent colectomy. A negative binomial model was fit to the pre-pandemic period and used to project expected monthly colectomy volumes after the pandemic onset. Standardized mean differences were calculated to compare patient and procedure characteristics. For continuous variables bootstrapping was used to estimate the medians. RESULTS: During the study period, 7756 patients in the 5% sample underwent colectomy (mean age 68.5 years, 84.6% White, 51.6% female). Mean monthly volumes were 133 (standard deviation (SD) ± 13) pre-pandemic versus 107 (SD ± 15) after pandemic onset. Observed volumes fell below expected April-June 2020. By June 2023, there was no "bump up" to recapture the estimated 159 "missed" cases (95% confidence interval (CI)-571, 1072). Patient characteristics, comorbidities, and hospitalizations remained similar between periods. However, median total Medicare payment increased after the pandemic onset ($18,431; 95% CI: $18,159-$18,635) compared to pre-pandemic ($17,768; 95% CI: $17,509-$17,962). CONCLUSIONS: Colectomy volumes for colon cancer declined following the onset of the COVID-19 pandemic and the "missed" cases were not recaptured by mid-2023. No particular demographic group was more affected than another. The "missed" cases likely represent people who died from COVID-19 or other causes before either being diagnosed with colon cancer or, less likely, before undergoing their colectomy. These findings can inform future epidemiologic estimates of population health and preparedness planning for recovery from future large scale disruptions.