Effect of Natural Disaster on Routine Surgery

BACKGROUND: We undertook this study to learn about the effect of Hurricane Katrina on routine surgery, using laparoscopic cholecystectomy (LC) as an index case. STUDY DESIGN: All inpatients with (LC) (DRG 493 and 494) and outpatients with principal procedure code 51.23 LC were included in the study. The time periods used were for the 7 months before Katrina compared with 7 months post-Katrina, starting 3 months after the storm when operating room volumes had returned to normal. Data points collected were operative time, length of stay, operating room turnover time, cost, revenue, surgery staff levels pre- and poststorm, and payer mix pre- and poststorm. RESULTS: Total cases were 196 prestorm and 167 poststorm for outpatient LC, and 62 prestorm and 64 poststorm for inpatient LC. Operative time, length of stay, and turnover time did not change significantly, despite staffing difficulties in the operative area. Poststorm cost decreased for both inpatient and outpatient LC. Revenue was down for inpatient LC and up slightly for outpatient. Decreased costs were largely from the loss of staff because of the storm, which meant that we were performing procedures with fewer staff. Our better payers decreased by 10.5% and Medicare, Medicaid, and private pay noninsured patients increased by 1%, 3.5%, and 6%, respectively. Change in profit was not significant. CONCLUSIONS: Hurricane Katrina opened the door to cost efficiencies for LC. But revenue went down because of increases in uninsured patients and fewer outpatient LCs. Efficiency remained stable despite the loss of staff. In planning for this type of disaster, be ready for large staff turnovers, a potential increase in uninsured patients, a diminished employment pool, and decreases in outpatient surgery. (J Am Coll Surg 2009;209:352-355. (C) 2009 by the American College of Surgeons)