Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

Impact of the Covid-19 pandemic on inpatient health care in Switzerland 2020-2021-A descriptive retrospective study using admission data of all Swiss hospitals

BACKGROUND

As part of the Covid-19-restrictions in Switzerland, a federal ban on non-urgent examinations and treatments was applied to all hospitals during six weeks in spring 2020 ("spring lockdown"). The aim of this study was to comprehensively investigate the consequences of the Covid-19 pandemic on Swiss inpatient admissions based on data of all hospitals, focusing on selected procedures of different medical urgency.

METHODS

The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year).

RESULTS

During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019.

CONCLUSIONS

The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.

Retrospective registry-based nationwide analysis of the COVID-19 lockdown effect on the volume of general and visceral non-malignant surgical procedures

Introduction

Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.

Materials and Methods

A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery ("Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie" or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients' characteristics, diagnoses, and treatments were analyzed.

Results

In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all p < 0.001), and cutaneous abscess (p = 0.01). The proportion of complicated appendicitis (p = 0.02), complicated hernia (p < 0.001), and complicated gallstone disease (choledocholithiasis p = 0.01; inflammation, p = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (p < 0.001).

Conclusions

The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.

Who was at risk of trauma-related injuries during the COVID-19 pandemic? A retrospective study from a level 1 trauma centre in Switzerland

INTRODUCTION

During the first wave of the COVID-19 pandemic, increasingly strict restrictions were imposed on the activities of the Swiss population, with a peak from 21 March to 27 April 2020. Changes in trauma patterns during the pandemic and the lockdown have been described in various studies around the world, and highlight some particularly exposed groups of people. The objective of this study was to assess changes in trauma-related presentations to the emergency department (ED) during the first wave of the COVID-19 pandemic, as compared to the same period in the previous year, with a particular focus on vulnerable populations.

MATERIALS AND METHODS

All trauma-related admissions to our ED in the first half of 2019 and 2020 were included. Patient demographics, trauma mechanism, affected body region, injury severity and discharge type were extracted from our hospital information system. Trauma subpopulations, such as interpersonal violence, self-inflicted trauma, geriatric trauma and sports-related trauma were analysed.

RESULTS

A total of 5839 ED presentations were included in our study, of which 39.9% were female. Median age was 40 years (interquartile range: 27-60). In comparison to 2019, there was a 15.5% decrease in trauma-related ED presentations in the first half of 2020. This decrease was particularly marked in the 2-month March/April period, with a drop of 36.8%. In 2020, there was a reduction in injuries caused by falls of less than 3 metres or by mechanical force. There was a marked decrease in sports-related trauma and an increase in injuries related to pedal cycles. Geriatric trauma, self-harm and assault-related injuries remained stable.

CONCLUSION

This study described changes in trauma patterns and highlighted populations at risk of trauma during the pandemic in Switzerland in the context of previous international studies.These results may contribute to resource management in a future pandemic.