P0422 - Association Between Endoscopy Performance and COVID-19-Related State Mask Mandates: An Analysis of the GIQuIC Registry

Award: Presidential Poster Award

Award: Presidential Poster Award

Audrey H. Calderwood, MD, MS, FACG¹, Michael S. Calderwood, MD, MPH¹, J. Lucas Williams, MPH², Jason A. Dominitz, MD, MHS^3
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; ²GI Quality Improvement Consortium, Bethesda, MD; ³VA Puget Sound Healthcare System, Seattle, WA

Introduction: At the start of the COVID-19 pandemic, non-urgent endoscopic procedures were deferred to reduce the spread of disease and conserve PPE. As the full scope of the pandemic became more apparent, endoscopy practices balanced concerns about disease transmission, deferred care, and business impact. Individual states adopted varying mask policies, which may reflect differences in attitudes toward the pandemic. The aim of this study was to quantify the impact of the pandemic on endoscopy volumes in the US and the association with timing of state mask mandates.

Methods: We performed a retrospective analysis of data from the GI Quality Improvement Consortium (GIQuIC) registry. Practices were categorized by state. Dates of universal state mask mandates were based on publicly available data (https://masks4all.co/what-states-require-masks/) and characterized as “early” (before 6/1/2020), “middle” (6/1/2020-8/31/2020) or “late” (9/1/2020 or after, including never). We compared monthly volumes of colonoscopy and EGD during the first 7 months of the pandemic from 3/2020 through 9/2020 to the same month in 2019. The primary outcome was the change in monthly volume of colonoscopy and EGD based on timing of state mask mandate.

Results: There were 451 eligible practices across 46 states and 2 territories with 3,514 endoscopists: 66.1% ambulatory surgery centers, 24.4% hospitals, and 9.5% other; 18.2% Northeast, 44.6% South, 16.6% Midwest, and 20.6% West. In terms of mask mandates, there were 16 early, 19 middle, and 17 late states. The decline in both colonoscopy and EGD volume was largest in early states and smallest in late states (Table). At the nadir in 4/2020, volume of colonoscopy and EGD was significantly lower at early vs. late sites (4.1 vs. 12.3%, p< .00001; 11.6 vs 24%, p< .00001). Late sites first acheived >90% pre-pandemic endoscopy volume in 6/2020 (with a subsequent drop and recovery), whereas early sites remained at < 90% pre-pandemic endoscopy volume through 9/2020 (Figure, p < .001 for 9/2020 comparison).

Discussion: The pandemic was associated with an abrupt curtailment of performance of colonoscopy and EGD. The pre-pandemic volumes had not recovered as of 9/2020. States with early mask mandates had greater decline and slower recovery of endoscopy volumes than those with late/no mask mandates. This study did not evaluate the association between mask mandates and other outcomes (e.g. number or severity of COVID-19 cases by state).


Figure: Figure. Comparison of volume of colonoscopy and EGD performed among GIQuIC practice, characterized by whether the state had an early, middle, or late/never mask mandate.

	Early states N=165 practices			Middle states N=209 practices			Late/never states N=77 practices
	2019	2020	%	2019	2020	%	2019	2020	%
	(a) Colonoscopy
March	51338	28526	55.6	69881	43070	61.6	30109	19104	63.4
April	54485	2254	4.1	74340	6644	8.9	33240	4094	12.3
May	55128	9207	16.7	74022	28206	38.1	31366	15374	49.0
June	50602	29894	59.1	69427	58385	84.1	29201	27444	94.0
July	51554	39569	76.8	74210	63224	85.2	30118	26582	88.3
August	50990	40094	78.6	75472	60910	80.7	31835	25644	80.3
September	48029	41881	87.2	69340	61688	89.0	28366	26155	92.2
	(b) EGD
March	11442	7033	61.5	15354	10157	66.2	5515	3303	59.9
April	11986	1396	11.6	16755	3225	19.2	6030	1445	24.0
May	12539	3664	29.2	17139	9018	52.6	5897	3239	54.9
June	11256	8307	73.8	15442	13762	89.1	5390	4860	90.2
July	11408	9495	83.2	16673	14437	86.6	5322	4880	91.7
August	11548	9098	78.8	16284	13729	84.3	5752	4674	81.3
September	11208	9332	83.3	15540	14063	90.5	5173	4809	93.0

Table: Table. Monthly volume of (a) colonoscopy and (b) EGD performed during the COVID-19 pandemic compared to the prior year (pre-pandemic) by timing of state mask mandate (early, middle, late/never).


Disclosures:
Audrey Calderwood: Dark Canyon Laboratories, LLC – Advisory Committee/Board Member, Stockholder/Ownership Interest (excluding diversified mutual funds).
Michael Calderwood indicated no relevant financial relationships.
J. Lucas Williams indicated no relevant financial relationships.
Jason Dominitz indicated no relevant financial relationships.


Audrey H. Calderwood, MD, MS, FACG¹, Michael S. Calderwood, MD, MPH¹, J. Lucas Williams, MPH², Jason A. Dominitz, MD, MHS³. P0422 - Association Between Endoscopy Performance and COVID-19-Related State Mask Mandates: An Analysis of the GIQuIC Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.