By James X. Stobinski
In this column, I would like to speak about another factor central to surgical care – the demand for surgery. Changes in demand have a direct impact on our continued issues with surgical staffing. I recently attended the Association of Anesthesia Clinical Directors (AACD) meeting in Orlando and the demand for surgery and our continued staffing issues were frequent topics of conversation at that meeting. In a future column, I will speak to the takeaway messages from that AACD meeting. But, for now, let’s return to the issue of demand.
My employer, NIFA, recently purchased the Life Science International (LSI) dataset detailing the volume of surgery from 2018-2021 and projections of surgical volume to 2026. The LSI data is well detailed with information on the overall U.S. population and surgery caseload broken down by surgical service and the site of care; inpatient versus outpatient. The LSI reveals that, “Surgical procedure volumes in the U.S. experienced a significant decline as a result of the COVID-19 pandemic, due to postponement or cancellation of elective procedures and, to a lesser degree, elimination of procedures that would have been performed on patients who die as a result of contracting COVID-19 disease.” (LSI, 2022).
Surgery volume rebounded sharply in 2021, which exacerbated our staffing issues. Beginning in 2022, we returned to a pattern of slow, steady growth in surgical volume in part due to an increase in the total U.S. population. However, in the LSI data we also see that the number of Americans 65 and older will increase more rapidly than the overall population and will reach 19.3% of the total population by 2026. These population shifts will increase our surgical workload.
The LSI data projects that the demand for surgery will continue to increase and that orthopedic surgical volume will rise at a rate exceeding the overall increase in surgical volume. Predictably enough with a rise in the numbers of older patients, the numbers of revision knee arthroplasties, hip arthroplasties and a diversity of spinal surgeries will also continue to increase. The LSI data also contains considerable information about the sites where surgical care will be done. Notably, more orthopedic surgery will shift to the outpatient setting to include total knee and hip procedures continuing a trend which accelerated during the pandemic.
Perioperative and perianesthesia nursing must shift their focus and skill set as more surgery transfers to the ambulatory setting. As more complex cases move out of the inpatient setting our workforce must change. In example, when total knee procedures are done in an ambulatory setting less nurses are needed for the episode of care as an inpatient, post-surgical unit is not needed. However, a broader nursing skill set is required in the ambulatory setting as nurses need pre-surgical and post-surgical care skills in addition to their intraoperative expertise.
These changes in the methods and sites of surgical care compel nurses to engage in lifelong learning as the skill set used in surgery 2 or 3 decades ago may no longer suffice. A predictable pattern in surgical care is underway. The data from LSI clearly points this out. There must now be a transformation in the education and training of the surgical care team as the practice of surgery evolves. With these shifts the work of perioperative nurse educators and preceptors becomes increasingly important. Just as NIFA adapted our training to accommodate technology such as robotic surgery we will need to re-evaluate other education and training programs in surgery. I look forward to these challenges as I begin my work at NIFA.
References
Life Science Intelligence (2022) LSI-PV-US2144SU: Surgical Procedure Volumes in the U.S. from 2018-2026: Executive Summary. [Technical report].
