Background: Increased outsourcing of ophthalmology surgeries has negative consequences for patients, who lose continuity of care, and for ophthalmology trainees, who experience reduced surgical volume. Purpose: To examine the utilization and outsourcing of ophthalmic surgeries at the Greater Los Angeles Veterans Affairs (VA) before, during, and after the COVID-19 pandemic, with a focus on implications for surgical training and patient outcomes. Methods: This retrospective cohort study was conducted within the Veterans Affairs Greater Los Angeles (GLA) Healthcare System, specifically at clinical sites staffed by ophthalmology residents. All ophthalmology patients sent for surgery from these sites were included. Data were sourced from internal and community care surgery request consults, including cases that were completed or discontinued during the study period. Results: Internal surgical requests declined by 47.3% during the pandemic compared with pre-pandemic levels (n = 923 vs. n = 1,611 p < 0.001). Concurrently, referrals to community care increased by 196.0%, peaking at 746 (p < 0.001). Post-pandemic, internal surgical requests rose to 1,258 of 1,864 total cases (67.5%) but remained significantly lower than pre-pandemic levels (p < 0.001), while community care referrals remained elevated at 32.5% (n = 606), a 140.5% increase compared with pre-pandemic levels (p < 0.001). Discontinued community care surgeries peaked at 34.5% of referrals during the pandemic (p = 0.002) and decreased to 26.2% after the pandemic, not significantly different from pre-pandemic levels (p = 0.492). Conclusions: The COVID-19 pandemic caused persistent disruptions to ophthalmic surgical services within the GLA VA, evidenced by reduced internal surgical volume and increased reliance on community care. These shifts highlight ongoing challenges in preserving surgical training opportunities and ensuring timely patient care, necessitating continued adaptation in both healthcare delivery and residency education.
Bisarya et al. (Tue,) studied this question.