Collateral Damage or Benefit? The Impacts of COVID-19 Induced Lockdown and Mandatory Screening Policy on Lung Surgery: Evidence from Wuhan

Background: The COVID-19 pandemic, accompanied by governments' regulatory restrictions to contain it, interfered with surgical services provision. We aimed to evaluate the impact of a 76-day city-wide lockdown in Wuhan, China, on the provision of four types of surgery and investigate the association between COVID-19 screening measures and the post-lockdown surge in lung surgery.  Methods: We collected data of four types of surgery: lung, esophagus, liver, and stomach, conducted between October 1, 2019, to July 31, 2020, from three major hospitals in Wuhan. We compared the demographic information of patients before and after the COVID-19 induced lockdown by surgery types. We then used difference-in-differences analysis to compare the volumes of lung surgery with three other types of surgery. We estimated the abnormal post-lockdown surge in lung surgery, accounting for scheduling delay. Next, we probed into the association between such abnormal increase in lung surgery and the mandatory chest CT scans required by the government as a COVID-19 screening measure using linear regression. Finally, we analyzed the proportion of lung cancer surgery and its demographic characteristics before and after the lockdown. Findings: After the lockdown started, all four types of surgery quickly dropped to a very low level and stayed at that minimum level throughout the lockdown period. Within 12 weeks after the lockdown was lifted, all three surgery types returned to and stayed at the pre-lockdown period except lung surgery, which surged to 150% of the pre-lockdown level. Specifically, the weekly volume of lung surgery in the post-lockdown period was 60% higher than that of esophagus surgery (95% CI, 0·31-0·90), 39% higher than that of liver surgery (95% CI, 0·17-0·63), and 24% higher than that of stomach surgery (95% CI, 0·01-0·47). Moreover, for every 1,000 chest CT scans conducted in week t-1, on average 3·5 (95% CI, 0·56-6·49) lung surgery were expected to occur in the week that followed. Besides, more young female patients received lung surgery after the lockdown [82 (58%) vs. 57 (45%)]. Finally, the fractions of post-lockdown lung cancer surgery were significantly greater than those in the pre-lockdown period (73% vs. 66%). Interpretation: The lockdown severely affected surgical services in Wuhan. Amid the recovery, the surge in lung surgery was associated with the large-scale chest CT screening policy implemented during and after the lockdown. Such a large-scale chest CT screening could be a blessing as it advanced the diagnosis window of lung diseases for young females. Funding: No funding is declared for this study. Declaration of Interests: None reported. Ethics Approval Statement: The authors have used data with the approval from the healthcare information system of three Triple-A accredited hospitals.