Surgical productivity did not suffer despite the states of emergency against the COVID-19 pandemic in Japan: a retrospective observational study.

BACKGROUND: The purpose of this study is to compute surgical total factor productivity with Malmquist index, and to evaluate the effects of states of emergency against the novel coronavirus disease 2019 (COVID-19) pandemic on its productivity change. We hypothesized that the states of emergency significantly reduced surgical total factor productivity in Japan. METHODS: The authors collected data from all the surgical procedures performed in Teikyo University Hospital from April 1 through September 30 in 2019-21. Non-radial and non-oriented Malmquist model under the variable returns-to-scale assumptions was employed. The decision making unit (DMU) was defined as a surgical specialty department. Inputs were defined as (1) the number of medical doctors who assisted surgery, and (2) the duration of surgical operation from skin incision to closure. The output was defined as the surgical fee for each surgery. The study period was divided into fifty-one ten- (or eleven-) day periods. We added all the inputs and outputs of the surgical procedures for each DMU during these study periods, and computed its Malmquist index, efficiency change and technical change. RESULTS: Seven thousand nine hundred and thirty-one surgical procedures were analyzed. The overall productivity and efficiency progressed significantly both during states of emergency and during no states of emergency. Our subgroup analysis demonstrated that there were no surgical specialties that had significantly different productivity, efficiency or technical changes between states of emergency and no states of emergency. CONCLUSIONS: We demonstrated that the surgical productivity did not suffer despite the states of emergency against the COVID-19 pandemic in Japan.