Research From Healthcare Team

Most Stayed on Track During Omicron Surge
The omicron surge rolled through hospitals between late December and late February. Sources in the Northeast and Southeast reported the earliest impacts from omicron, between late December and late January, while sources in other regions, including the Midwest, Mid-Atlantic and West, had a later impact during February.

In OTR Global’s March 22 Robotic Surgery report, most sources were able to work through the omicron variant with limited effect on Intuitive Surgical Inc. da Vinci procedures, as 19 of 26 said their 1Q22 da Vinci procedures at least met their expectations. Meanwhile, seven (mainly in the Midwest, Mid-Atlantic and Northwest) fell below expectations because of the omicron surge. Despite the lingering pandemic effects for some during 1Q22, sources overall maintained their forecasts from December for 2022 da Vinci procedure volumes.

In the April 12 Joint Replacement Lower Extremity report, which focused on hip and knee replacements, only two of 21 sources cited some negative effects from the omicron surge during 1Q22, an improvement from nine of 22 in January’s report. Sources said the continued move of hip and knee replacement procedures to the outpatient setting, especially ambulatory surgery centers, mitigated the effect of omicron on hospital resources. As a result, sources maintained their forecasts for 2022 knee and hip replacement procedures since January.

Similar to OTR Global’s findings on robotic surgery and lower extremity joint replacements, cardiac pumps experienced limited impact from the omicron surge during 1Q22 (as noted in OTR Global’s April 19 report). Fifteen of 20 sources said the pandemic had no effect or a positive effect on Abiomed Inc.’s Impella use during 1Q22. As a result, forecasts for 2022 Impella procedures were the same (13) or better (six) for 19 of 20 sources since January.

Although sources in the Feb. 28 Transcatheter Aortic Valve Replacement (TAVR) report maintained their 2022 yy outlooks, effects from the omicron surge took a toll on 1Q22 procedures. Specifically, 11 of 20 sources said the pandemic had either a minor (eight) or major (three) negative effect on their 1Q22 TAVR procedures. Sources attributed this to a combination of the ability to perform procedures within the hospital during the surge and a lack of staff to support the procedures. However, sources remained optimistic this would be resolved as the surge subsided and some reported issues had already started to clear up.

Quotes

• “We haven’t had any slowdown due to pandemic recently. There are and were situations when patients would get sick and then we would have to take them off of the schedule, but that hasn’t affected our volumes.” Robotic surgery coordinator in Louisiana (March 22 Robotic Surgery report)
• “We were down during 1Q22 because of the omicron surge in February. We were slow, but things have ramped back up pretty quickly.” Robotic surgery coordinator in Oregon (March 22 Robotic Surgery report)
• “We are back to our full hip and knee replacement procedure volumes. Omicron caused a little dip in December that continued into January, but then we quickly rebounded. Our numbers during 1Q22 were about the same as in 4Q21. We have even lifted all precautionary measures like visitations and in-person meetings.” Orthopedic surgeon in New York (April 12 Joint Replacement report)
• “We aren’t really experiencing any pandemic-related issues here now. Our PCI volumes have pretty much returned to normal.” Interventional cardiologist in Ohio (April 19 Cardiac Pumps report)
• “We were really hit hard by the latest COVID wave starting at the end of last year. We didn’t perform our first TAVR this year until mid-January. And after that, we only performed about one per week. We didn’t have the beds available, and at one point we had over 100 nurses out with COVID.” TAVR coordinator in Florida (Feb. 28 TAVR report)

Staffing Issues Worst for TAVR
Among OTR Global’s four reports covering hospitals, staffing issues had the greatest impact on TAVR procedures during 1Q22. In the TAVR report, staffing shortages hindered TAVR volumes for nine of 20 sources. Among the nine sources, seven said the staffing issues were connected to the omicron surge, while five said they were coping with a wider staffing shortage that stemmed from earlier in the pandemic (three sources reported both). TAVR sources reported the omicron-related staffing issues were resolving during February. Procedures using Impella cardiac pumps were less affected by staffing problems, likely because procedures using Impella are more emergent, and only three of 20 sources said staffing issues were affecting 1Q22 Impella volumes. 

In OTR Global’s Robotic Surgery report, 14 of 26 sources said staffing and nursing shortages caused disruptions in scheduling da Vinci procedures during 1Q22, but did not necessarily impact volumes. Meanwhile, in Joint Replacement, six of 22 sources said staffing issues limited hip and knee procedures during 1Q22.

Quotes

• “Staffing is a problem for everyone. We are having problems keeping nurses and finding new nurses to expand volume. I don’t know if we will ever go back to the old pre-pandemic paradigm. The new generation is more in tune with a work/life balance, and it isn’t a bad thing, but it is at odds with the way that healthcare providers have viewed their profession in the past. There are now more pathways for RNs to get advanced degrees and make more money and have better hours. I think we are going to have to change the paradigm.” TAVR coordinator (Feb. 28 TAVR report)
• “Definitely more people ask about TAVR than ever before, but we can only do so many with our surgery days and staff.” TAVR coordinator (Feb. 28 TAVR report)
• “Staffing shortages are manageable, also not affecting robotic surgery cases.” Robotic surgery coordinator (March 22 Robotic Surgery report)
• “Traveling nurses and staff are difficult to keep, and it is hard to find qualified permanent staff. There’s a limit to pay them. They are earning two to three times a regular paycheck and drive 60 miles. We don’t want to turn down joint replacement procedures because they’re profitable, and we’re not stopping our cases — but it hasn’t been easy.” Nursing manager (April 12 Joint Replacement report)

Supply Issues Emerge for Robotic Surgery but Not Hurting Procedure Volume
Among the four reports, supply issues were most notable during 1Q22 for robotic surgery sources. Five robotic surgery sources reported supply issues, including three who cited difficulty obtaining da Vinci robot system consumables. Sources said these supply issues have not affected robotic surgery volumes so far but have the potential to if issues worsen. In addition, one reported a delay in delivery of their da Vinci robot, which they believed was related to supply challenges.

Meanwhile, in Joint Replacement, two sources reported supply issues for consumables used during hip and knee replacement surgeries. However, no source noted any supply problems directly tied to hip and knee implants, an improvement from OTR Global’s January report, when one reported a hip implant supply issue.

No supply issues were reported by sources in OTR Global’s reports on TAVR or cardiac pumps.

Quotes

• “We have supplies that are on backorder, and we’re paying for overnight shipping fees to get what we need.” Robotic surgery coordinator (March 22 Robotic Surgery report)
• “We had some supply challenges last week with the drape for the robotic arm. We called da Vinci, and they were able to help us out. The sales representative has been here a couple of times, a little more than usual, helping us to work through supply issues.” Robotic surgery coordinator (March 22 Robotic Surgery report)
• “Staplers have been on backorder for several months, and we were bartering and pleading from other hospitals to get them. We were down to none. Right now, we can’t get the long operators. We just got a phone call that the Synchroseal is now on backorder. Our materials team has done a fantastic job along with our Intuitive sales representative with cross-checking our volumes and inventory to make sure that we don’t fall behind as a result of this.” Robotic surgery coordinator (March 22 Robotic Surgery report)