# Inpatient to Outpatient Shifts in Surgical Care: Persistence of COVID-19 Era Changes and Socioeconomic Variations

## TL;DR

The study shows that many surgeries moved from hospitals to outpatient settings during the pandemic and that these changes have lasted, with bigger impacts on lower-income patients.

## Contribution

The paper provides new evidence on the persistence of inpatient to outpatient surgical shifts and their socioeconomic disparities post-pandemic.

## Key findings

- Inpatient volumes decreased for 9 of the 20 most common pre-pandemic inpatient procedures, with outpatient use increasing.
- Hip and knee replacements saw the largest shift, with inpatient shares dropping over 40 percentage points.
- Lower-income patients experienced a 6.0% decline in procedure volumes, while higher-income patients saw a 5.2% increase.

## Abstract

The COVID-19 pandemic disrupted surgical care delivery, yet the extent to which shifts from inpatient to outpatient settings have persisted remains unclear. Using medical claims data from Independence Blue Cross (2018–2022), we examined changes in surgery settings across 102 procedures before the pandemic and during the 2 years following the suspension of elective surgeries. After 2 years, inpatient volumes decreased for 9 of the 20 most common pre-pandemic inpatient procedures, with corresponding increases in outpatient utilization. Hip and knee replacements experienced the most pronounced shifts, with inpatient shares falling by more than 40 percentage points. Patients from lower-income census tracts saw greater declines in overall procedure volumes (–6.0%) compared to those from higher-income areas (+5.2%). Total allowed amounts decreased for procedures with outpatient migration, while out-of-pocket costs remained stable. These findings suggest durable, post-pandemic shifts in surgical care delivery patterns, with potential implications for access, costs, and equity.