Differential Effects of the COVID-19 Pandemic on Surgical Utilization by Procedure Type: Analysis of Korean National Health Insurance Data [2017–2021]

<b>Objectives:</b> The coronavirus disease 2019 (COVID-19) pandemic caused severe disruptions in healthcare services worldwide; however, its differential effects on surgical utilization have not been fully examined. This study aimed to analyze trends in three major surgery types-cataract, spine, and joint replacement-across regions and healthcare institutions in Korea and to evaluate how the pandemic affected surgical utilization according to surgery type, urgency, and care setting. <b>Methods:</b> The Korean National Health Insurance Service data collected from 2017 to 2021 were used to analyze trends in three major surgery typesacross 17 regions and eight categories of healthcare institutions in Korea. The effects of the pandemic were examined using an interrupted time-series analysis to compare annual growth rates and identify patterns during 2019-2021. <b>Results:</b> Our findings revealed distinct patterns based on the type of surgery. Cataract surgery (+4.8% compared with 2019) and spine surgery (+5.0%) continued to increase in 2020; however, the number of joint replacement surgeries decreased (-2.9%). Metropolitan areas showed greater resilience than rural regions, indicating regional disparities. At the institutional level, outpatient-focused clinics performed cataract surgeries, whereas hospital-based procedures showed variable trends. In addition, the differences correlated with surgical urgency: elective procedures continued to increase, whereas semi-urgent procedures decreased. <b>Conclusions:</b> during the pandemic, surgical utilization varied according to surgery type, urgency, and regional characteristics. These findings provide context-specific evidence for policymakers to prioritize surgical services during health crises and offer strategies to sustain essential surgical care across diverse healthcare settings and regions.