Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy

ObjectivesDuring 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and reduce the overall volumes of treatments.The aim of this paper is to analyse whether the pandemic and the prioritisation policies on elective surgery were done considering the potential inappropriateness highlighted by the measurement of geographic variation.SettingThe setting of the study is acute care with a focus on elective surgical procedures. Data were analysed at the Italian regional level.ParticipantsThe study is observational and relies on national hospitalisation records from 2019 to 2020. The analyses refer to the 21 Italian regional health systems, using 48 917 records for 2019 and 33 821 for 2020. The surgical procedures analysed are those considered at high risk of unwarranted variation: coronary angioplasty, cholecystectomy, colectomy, knee replacement, hysterectomy, tonsillectomy, hip replacement and vein stripping.Primary and secondary outcome measuresPrimary measures were the hospitalisation rate and its reduction per procedure, to understand the level of potential inappropriateness. Secondary measures were the SD and high/low ratio, to map the level of geographic variation.ResultsFor some procedures, there is a linear negative relationship (eg, tonsillectomy: ρ = −0.92, p