Background The COVID pandemic significantly affected surgical care by postponing many elective interventions. The consequences were seen in patients’ clinical presentation and cost of care. The purpose of this article is to evaluate changes in the emergency-to-elective surgery ratio at a tertiary hospital across pre-pandemic, pandemic, and early post-pandemic periods. Methods We conducted a retrospective review at a community tertiary care hospital in southern California. We analyzed emergency and elective surgeries from January 2019 to December 2023 based on three time periods: Pre-pandemic (Jan 2019-March 2020), pandemic (April 2020-December 2021), and post-pandemic periods (Jan 2022-Dec 2023). In-hospital complication rates and costs of surgery were collected and compared between the groups. Results A total of 20,409 patients were included in the analysis. 14,361 (70.4%) underwent emergency surgery while 6,048 (29.6%) had elective surgery. The emergency to elective surgery ratio pre-pandemic, pandemic, and post-pandemic were 1.5, 3.1, and 2.9 ( P <0.001), respectively. Complications rates pre-pandemic, pandemic, and post-pandemic were 4.5%, 3.2%, and 4.6% ( P <0.001). Across all 3 time periods, elective general surgery offered a higher net revenue compared to emergency general surgery cases ( P <0.001). Conclusion At this tertiary hospital, elective surgical volume demonstrated only partial recovery following the COVID-19 pandemic, resulting in a persistently elevated emergency-to-elective surgery ratio through the end of 2023. This represents an opportunity to direct quality improvement efforts to promote surgical access to elective surgery to potentially reduce complication rates and decrease costs of care.
Shu-Yip et al. (2026) studied this question.