IMPORTANCE The COVID-19 pandemic is associated with decreased surgical procedure volumes, but existing studies have not investigated this association beyond the end of 2020, analyzed changes during the post-vaccine release period, or quantified these changes by patient acuity. OBJECTIVE To quantify changes in the volume of surgical procedures at a 1017-bed academic quaternary care center from January 6, 2019, to December 31, 2021. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 129 596 surgical procedure volumes were retrospectively analyzed during 4 periods: pre-COVID-19 (January 6, 2019, to January 4, 2020), COVID-19 peak (March 15.2020, to May 2, 2020), post-COVID-19 peak (May 3, 2020, to January 2, 2021), and post-vaccine release (January 3, 2021, to December 31, 2021). Surgery volumes were analyzed by subspecialty and case class (elective, emergent, nonurgent, urgent). Statistical analysis was by autoregressive integrated moving average modeling. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the change in weekly surgical procedure volume across the 4 COVID-19 periods. RESULTS A total of 129 596 records of surgical procedures were reviewed. During the COVID-19 peak, overall weekly surgical procedure volumes (mean [SD] procedures per week, 40 6.0 0 [171.45]; 95% CI, 234.56-577.46) declined 44.6% from pre-COVID-19 levels (mean [SD] procedures per week, 732.37 [12.70]; 95% CI, 719.67-745.08; P < .001). This weekly volume decrease occurred across all surgical subspecialties. During the post-COVID peak period, overall weekly surgical volumes (mean [SD] procedures per week, 624.31 [142.45]; 95% CI, 481.85-766.76) recovered to only 85.8% of pre-COVID peak volumes (P < .001). This insufficient recovery was inconsistent across subspecialties and case classes. During the post-vaccine release period, although some subspecialties experienced recovery to pre-COVID-19 volumes, others continued to experience declines. CONCLUSIONS AND RELEVANCE This quaternary care institution effectively responded to the pressures of the COVID-19 pandemic by substantially decreasing surgical procedure volumes during the peak of the pandemic. However, overall surgical procedure volumes did not fully recover to pre-COVID-19 levels well into 2021, with inconsistent recovery rates across subspecialties and case classes. These declines suggest that delays in surgical procedures may result in potentially higher morbidity rates in the future. The differential recovery rates across subspecialties may inform institutional focus for future operational recovery.

In March of 2020, hospitals across the United States began deferring elective surgical procedures in response to the rapidly escalating SARS-CoV2 pandemic.On March 15, 2020, the Massachusetts Department of Public Health (DPH) issued a directive that all non-essential surgery be deferred [1].Massachusetts General Hospital (MGH) needed to quickly evolve surgical scheduling guidelines that were clear, reasonable and fair to meet the needs of our patients and balance the evolving needs of our hospital and healthcare system.On March 17, 2020, the American College of Surgery (ACS) published guidance for triage of non-emergent surgery [2].A method was needed to quickly draw-down our operating room (OR) schedule to be in line with the ACS guidelines and more detailed guidelines that we developed.This was necessary given the rising need to conserve space, staffing and PPE resources.We describe a method for case deferment that empowers a large swath of surgical specialties to make safe and quick decisions that result in a dramatic reduction of the OR schedule and hospital census.The following rules and methodology have applicability for our current pandemic as well as during other emergency situations such as blizzards, hurricanes or massive power outage.