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Sankar A, Stukel TA, Baxter NN, Wijeysundera DN, Hwang SW, Wilton AS, Chan TCY, Sarhangian V, Simpson AN, de Mestral C, Pincus D, Campbell RJ, Urbach DR, Irish J, Gomez D. Disparities in surgery rates during the COVID-19 pandemic: retrospective study. BJS Open 2024; 8:zrae088. [PMID: 39186678 PMCID: PMC11346633 DOI: 10.1093/bjsopen/zrae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/11/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024] Open
Affiliation(s)
- Ashwin Sankar
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Vahid Sarhangian
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Charles de Mestral
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Pincus
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Campbell
- ICES, Toronto, Ontario, Canada
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - David R Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, University Health Network, University of Toronto, and Cancer Care Ontario-Ontario Health, Toronto, Ontario, Canada
| | - David Gomez
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Telesnicki TT, Simpson AN, de Mestral C, Baxter NN, Urbach DR, Gomez D. Recommendations for Recovery of the COVID-19 Pandemic-related Diagnostic, Screening, and Procedure Backlog in Ontario: A Survey of Healthcare Leaders. CLIN INVEST MED 2024; 47:4-11. [PMID: 38958478 DOI: 10.3138/cim-2024-2655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership positions is urgently needed to inform a comprehensive provincial recovery strategy. METHODS A list of 20 policy recommendations addressing the diagnostic, screening and procedure backlog in Ontario were transformed into a national online survey. Policy recommendations were rated on a 7-point Likert scale (strongly agree to strongly disagree) and organized into those retained (≥75% strongly agree to somewhat agree), discarded (≥80% somewhat disagree to strongly disagree), and no consensus reached. Survey participants included a diverse sample of healthcare leaders with the potential to impact policy reform. RESULTS Of 56 healthcare leaders invited to participate, there were 34 unique responses (61% response rate). Participants were from diverse clinical backgrounds, including surgical subspecialties, medicine, nursing, and healthcare administration and held institutional or provincial leadership positions. A total of 11 of 20 policy recommendations reached the threshold for consensus agreement with the remaining 9 having no consensus reached. CONCLUSION Consensus agreement was reached among Canadian healthcare leaders on 11 policy recommendations to address the diagnostic, screening, and procedure backlog in Ontario. Recommendations included strategies to address patient information needs on expected wait times, expand health and human resource capacity, and streamline efficiencies to increase operating room output. No consensus was reached on the optimal funding strategy within the public system in Ontario or the appropriateness of implementing private funding models.
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Affiliation(s)
- Teagan T Telesnicki
- Department of General Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrea N Simpson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David R Urbach
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of General Surgery, Women's College Hospital, Toronto, ON, Canada
| | - David Gomez
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of General Surgery, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
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Alzerwi NAN, Rayzah M, Alnemare AK, Elkhalifa AME. Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies. Healthcare (Basel) 2023; 12:96. [PMID: 38201002 PMCID: PMC10779415 DOI: 10.3390/healthcare12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. METHODS We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. RESULTS An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. CONCLUSIONS This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Ahmad K. Alnemare
- Otolaryngology Department, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia;
| | - Ahmed M. E. Elkhalifa
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673, Saudi Arabia;
- Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti 1158, Sudan
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Ibadin S, Brindle M, Wasylak T, Robert J, Litvinchuk S, Sauro KM. Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan. Int J Health Policy Manag 2023; 12:8007. [PMID: 38618771 PMCID: PMC10843432 DOI: 10.34172/ijhpm.2023.8007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response. METHODS This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis. RESULTS We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making). CONCLUSION This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.
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Affiliation(s)
- Seremi Ibadin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Tracy Wasylak
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Jill Robert
- Surgery and Bone & Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Stacey Litvinchuk
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Khara M. Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Daza JF, Wijeysundera HC, Diep C, Ladha KS, Cuthbertson BH, Wijeysundera DN. Healthcare Costs of New Functional Impairment in the Year after Noncardiac Surgery. Anesthesiology 2023; 139:902-904. [PMID: 37874043 DOI: 10.1097/aln.0000000000004674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Gomez D, de Mestral C, Stukel TA, Irish J, Simpson AN, Wilton AS, Rotstein OD, Campbell RJ, Eskander A, Urbach DR, Baxter NN. Characterizing the Impact of Procedure Funding on the Covid-19 Generated Procedure Gap in Ontario: A Population-Based Analysis. Ann Surg 2023; 278:e719-e725. [PMID: 36538613 DOI: 10.1097/sla.0000000000005781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgical procedures in Canada were historically funded through global hospital budgets. Activity-based funding models were developed to improve access, equity, timeliness, and value of care for priority areas. COVID-19 upended health priorities and resulted in unprecedented disruptions to surgical care, which created a significant procedure gap. We hypothesized that activity-based funding models influenced the magnitude and trajectory of this procedure gap. METHODS Population-based analysis of procedure rates comparing the pandemic (March 1, 2020-December 31, 2021) to a prepandemic baseline (January 1, 2017-February 29, 2020) in Ontario, Canada. Poisson generalized estimating equation models were used to predict expected rates in the pandemic based on the prepandemic baseline. Analyses were stratified by procedure type (outpatient, inpatient), body region, and funding category (activity-based funding programs vs. global budget). RESULTS In all, 281,328 fewer scheduled procedures were performed during the COVID-19 period compared with the prepandemic baseline (Rate Ratio 0.78; 95% CI 0.77-0.80). Inpatient procedures saw a larger reduction (24.8%) in volume compared with outpatient procedures (20.5%). An increase in the proportion of procedures funded through activity-based programs was seen during the pandemic (52%) relative to the prepandemic baseline (50%). Body systems funded predominantly through global hospital budgets (eg, gynecology, otologic surgery) saw the least months at or above baseline volumes, whereas those with multiple activity-based funding options (eg, musculoskeletal, abdominal) saw the most months at or above baseline volumes. CONCLUSIONS Those needing procedures funded through global hospital budgets may have been disproportionately disadvantaged by pandemic-related health care disruptions.
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Affiliation(s)
- David Gomez
- Division of General Surgery, St. Michael's Hospital
- Li Ka Shing Knowledge Institute
- Department of Surgery, Temetry Faculty of Medicine
- Institute of Health Policy, Management, and Evaluation
- ICES, Toronto, ON, Canada
| | - Charles de Mestral
- Li Ka Shing Knowledge Institute
- Department of Surgery, Temetry Faculty of Medicine
- Institute of Health Policy, Management, and Evaluation
- ICES, Toronto, ON, Canada
| | | | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto
| | - Andrea N Simpson
- Li Ka Shing Knowledge Institute
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Unity Health Toronto
| | | | - Ori D Rotstein
- Division of General Surgery, St. Michael's Hospital
- Li Ka Shing Knowledge Institute
- Department of Surgery, Temetry Faculty of Medicine
| | - Robert J Campbell
- Department of Ophthalmology, Kingston Health Science Centre, Queens University, Kingston
- ICES, Toronto, ON, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management, and Evaluation
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre
- ICES, Toronto, ON, Canada
| | - David R Urbach
- Department of Surgery, Temetry Faculty of Medicine
- Institute of Health Policy, Management, and Evaluation
- ICES, Toronto, ON, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute
- Department of Surgery, Temetry Faculty of Medicine
- Institute of Health Policy, Management, and Evaluation
- ICES, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Muacevic A, Adler JR. The Impact of the COVID-19 Pandemic on Surgical Activities: A Single-Center Experience and Literature Review. Cureus 2022; 14:e30785. [PMID: 36447702 PMCID: PMC9701314 DOI: 10.7759/cureus.30785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/25/2023] Open
Abstract
Aim The aim of this article is to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on our surgical department, which is situated in Athens, Greece, as well as to review published literature on the COVID-19 pandemic's impact on surgical activities in our department. Material and methods We retrospectively reviewed the surgical procedures that were performed in the surgical department of a tertiary University hospital in Athens, Greece, before and during the pandemic. Furthermore, we performed a literature review evaluating articles on surgical activity and COVID-19 published from the beginning of the pandemic up until the January of 2022 on the PubMed database. Results In total, 894 patients were included in the study. Of those, 264 (29.5%) underwent surgery during the control period and 630 (70.5%) in the pandemic period. Overall, we performed 20.5% fewer surgeries in the post-sanitary period. In particular, elective surgeries decreased on average by 23.9%, emergency procedures decreased by 8.9%, and oncology surgeries increased by an average of 6.4% after the year 2020. Concerning the review of literature, 51 studies were selected for this review. According to them, the main effect of the pandemic on the surgical sector was reflected in the reduction of total surgeries, mainly due to the postponement of elective surgical procedures, which showed a median reduction of 54% compared to the pre-COVID-19 period. A smaller decrease was observed in the number of emergency and oncological surgeries. Conclusions Reduced surgical activity during the pandemic, due to the health measures imposed, requires courageous corrective interventions to avoid its adverse effects, such as disease progression, increased treatment costs, reduced quality of life, and ultimately the survival of the patients.
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Rachamin Y, Meyer MR, Rosemann T, Grischott T. Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland - A Retrospective Study Based on Insurance Claims Data. Int J Health Policy Manag 2022; 12:6932. [PMID: 36243943 PMCID: PMC10125178 DOI: 10.34172/ijhpm.2022.6932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease 2019 (COVID-19), yet the impact on elective and emergency inpatient procedure volumes is unclear. METHODS We analyzed anonymized data on 234 921 hospitalizations in 2017-2020 (55.9% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre-pandemic data, the expected weekly numbers of procedures in 2020 in the absence of a pandemic and compared these to the observed numbers in 2020. Compensation effects were investigated by discretely integrating the difference between the two numbers over time. RESULTS During the first COVID-19 wave in spring 2020, elective procedure numbers decreased by 52.9% (95% confidence interval -64.5% to -42.5%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by 45.5% and 72.4%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of -9.9% (-15.8% to -4.5%) for the whole year 2020. Emergency procedure numbers also decreased by 17.1% (-23.7% to -9.8%) during the first wave, but over the whole year 2020, net emergency procedure volumes were similar to control years. CONCLUSION Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non-COVID-19 related care is maintained during future pandemic phases in order to prevent negative health consequences.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Matthias R. Meyer
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
- ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
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A Population-based Analysis of the COVID-19 Generated Surgical Backlog and Associated Emergency Department Presentations for Inguinal Hernias and Gallstone Disease. Ann Surg 2022; 275:836-841. [PMID: 35081578 PMCID: PMC9083314 DOI: 10.1097/sla.0000000000005403] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the downstream effects of the COVID-19 generated surgical backlog. BACKGROUND Delayed elective surgeries may result in emergency department (ED) presentations and the need for urgent interventions. METHODS Population-based repeated cross-sectional study utilizing administrative data. We quantified rates of elective cholecystectomy and inguinal hernia repair and rates of ED presentations, urgent interventions, and outcomes during the first and second waves of COVID-19 (March 1, 2020-February 28, 2021) as compared to a 3-year pre-COVID-19 period (January 1, 2017-February 29, 2020) in Ontario, Canada. Poisson generalized estimating equation models were used to predict expected rates during COVID-19 based on the pre-COVID-19 period. The ratio of observed (actual events) to expected rates was generated for surgical procedures (SRRs) and ED visits (ED-RRs). RESULTS We identified 74,709 elective cholecystectomies and 60,038 elective inguinal hernia repairs. During the COVID-19 period, elective inguinal hernia repairs decreased by 21% (SRR 0.791; 0.760-0.824) whereas elective cholecystectomies decreased by 23% (SRR 0.773; 0.732-0.816). ED visits for inguinal hernia decreased by 17% (ED-RR 0.829; 0.786-0.874) whereas ED visits for gallstones decreased by 8% (ED-RR 0.922; 0.878-0.967). A higher population rate of urgent cholecystectomy was observed, particularly after the first wave (SRR 1.076; 1.000-1.158). No difference was seen in inguinal hernias. CONCLUSIONS An over 20% reduction in elective surgeries and an increase in urgent cholecystectomies was observed during the COVID-19 period suggesting a rebound effect secondary to the surgical backlog. The COVID-19 generated surgical backlog will have a heterogeneous downstream effect with significant implications for surgical recovery planning.
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de Mestral C, Gomez D, Wilton AS, Lee DS, Albalawi Z, Austin PC, Jacob-Brassard J, Urbach DR, Al-Omran M, Baxter NN. A Population-Based Analysis of Diabetes-Related Care Measures, Foot Complications, and Amputation During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open 2022; 5:e2142354. [PMID: 34985514 PMCID: PMC8733837 DOI: 10.1001/jamanetworkopen.2021.42354] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. OBJECTIVE To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. MAIN OUTCOMES AND MEASURES Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). RESULTS On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. CONCLUSIONS AND RELEVANCE In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.
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Affiliation(s)
- Charles de Mestral
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - David Gomez
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - Douglas S. Lee
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Zaina Albalawi
- Division of Endocrinology and Metabolism, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | | | - Jean Jacob-Brassard
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - David R. Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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12
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Baxter NN, Facey M, Ruco A, Baker NA, Sorvari A, Benmessaoud A, Dube C, Rabeneck L, Tinmouth J. Nimble Approach: fast, adapting, calculating and ethically mindful approach to managing colorectal cancer screening programmes during a pandemic. BMJ Open Gastroenterol 2022; 9:e000826. [PMID: 35046092 PMCID: PMC8772416 DOI: 10.1136/bmjgast-2021-000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe a conceptual framework that provides understanding of the challenges encountered and the adaptive approaches taken by organised colorectal cancer (CRC) screening programmes during the initial phase of the COVID-19 pandemic. DESIGN This was a qualitative case study of international CRC screening programmes. Semi-structured interviews were conducted with programme managers/leaders and programme experts, researchers and clinical leaders of large, population-based screening programmes. Data analysis, using elements of grounded theory, as well as cross-cases analysis was conducted by two experienced qualitative researchers. RESULTS 19 participants were interviewed from seven programmes in North America, Europe and Australasia. A conceptual framework ('Nimble Approach') was the key outcome of the analysis. Four concepts constitute this approach to managing CRC screening programmes during COVID-19: Fast (meeting the need to make decisions and communicate quickly), Adapting (flexibly and creatively managing testing/colonoscopy capacity, access and backlogs), Calculating (modelling and actively monitoring programmes to inform decision-making and support programme quality) and Ethically Mindful (considering ethical conundrums emerging from programme responses). Highly integrated programmes, those with highly integrated communication networks, and that managed greater portions of the screening process seemed best positioned to respond to the crisis. CONCLUSIONS The Nimble Approach has potentially broad applications; it can be deployed to effectively respond to programme-specific challenges or manage CRC programmes during future pandemics, other health crises or emergencies.
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Affiliation(s)
- Nancy N Baxter
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Graduate Department of Pharmaceutical Sciences, University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Marcia Facey
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Graduate Department of Pharmaceutical Sciences, University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Arlinda Ruco
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Natalie A Baker
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Anne Sorvari
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Amina Benmessaoud
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Catherine Dube
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Care Ontario, Prevention and Cancer Control, Ontario Health, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Cancer Care Ontario, Prevention and Cancer Control, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Cancer Care Ontario, Prevention and Cancer Control, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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13
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Erman A, Ramsay LC, Sander B, Haj-Ali W, Wu D, Setterfield M, Rahal M, Woodward G, Al-Omran M, de Mestral C. Impact of COVID-19 on scheduled lower extremity revascularization for chronic limb-threatening ischemia. Br J Surg 2021; 109:e5-e7. [PMID: 34878108 PMCID: PMC9383050 DOI: 10.1093/bjs/znab404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Aysegul Erman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren C Ramsay
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Deanna Wu
- CorHealth Ontario, Toronto, Ontario, Canada
| | | | | | | | - Mohammed Al-Omran
- Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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de Mestral C, Gomez D, Sue-Chue-Lam C, Dossa F, Nantais J, Simpson AN, Urbach D, Austin PC, Wilton AS, Baxter NN. Variable impact of COVID-19 on urgent intervention in Ontario. Br J Surg 2021; 108:e266-e267. [PMID: 33899084 PMCID: PMC8135473 DOI: 10.1093/bjs/znab121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 11/14/2022]
Abstract
COVID-19 had a variable impact on urgent interventions among hospitalized patients in Ontario Canada.
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Affiliation(s)
- C de Mestral
- Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - D Gomez
- ICES, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - C Sue-Chue-Lam
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - F Dossa
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Nantais
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - A N Simpson
- ICES, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - D Urbach
- ICES, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - N N Baxter
- ICES, Toronto, Ontario, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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