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Kang T, Lee Y, Kang M. Impact of COVID-19 on healthcare utilization among chronic disease patients in South Korea. Prev Med Rep 2024; 41:102680. [PMID: 38524274 PMCID: PMC10959695 DOI: 10.1016/j.pmedr.2024.102680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
Background From 2020 to 2022, South Korea has experienced significant direct and indirect damage because of the coronavirus pandemic. Preventive measures aimed at controlling the spread of the virus have inadvertently limited healthcare accessibility for patients without COVID-19, leading to detrimental consequences, particularly for patients with chronic diseases. Hence, there is a growing need to comprehensively examine the changes in healthcare utilization among patients with chronic diseases owing to the COVID-19 pandemic, along with the associated factors and health outcomes. Methods To examine changes in healthcare utilization among patients with chronic diseases and their impact on health outcomes, we used the NHIS database. Logistic regression analysis was used to investigate changes in healthcare utilization, and a two-part model was applied to explore the effects of reduced healthcare utilization on hospitalization status and length of hospital stay. Results Since the onset of the pandemic, the likelihood of hospitalization has been 1.10 times higher than that during pre-pandemic times in the population groups with a 20 % decrease in outpatient healthcare utilization. Notably, individuals belonging to the low-income group exhibited a 1.77-fold higher likelihood of hospitalization than those in the high-income group. Furthermore, in cases where hospitalization could have been avoided, low-income individuals had an extended hospital stay of 16.7 days compared with high-income individuals. Conclusion There is a need for a more proactive approach for classifying patients with chronic diseases based on various vulnerability factors to effectively respond to future novel infectious diseases and reduce the long-term burden on the nation.
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Affiliation(s)
- Taeuk Kang
- Health and Wellness College, Sungshin Women’s University Woonjung Green Campus, Seoul, Republic of Korea
| | - Yoonkyoung Lee
- BK21 Center for Integrative Responses to Health Disasters, Seoul National University Graduate School of Public Health, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Minku Kang
- Department of Preventive Medicine, Korea University College of Medicine 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, South Korea
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Osterman E, Jakobsson S, Larsson C, Linder F. Effect of the COVID-19 pandemic on the care for acute cholecystitis: a Swedish multicentre retrospective cohort study. BMJ Open 2023; 13:e078407. [PMID: 38035739 PMCID: PMC10689379 DOI: 10.1136/bmjopen-2023-078407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES The present study aimed to investigate if and how the panorama of acute cholecystitis changed in 2020 in Sweden. Seven aspects were identified, the incidence of cholecystitis, the Tokyo grade, the timing of diagnosis and treatment, the proportion treated with early surgery, the proportion of patients treated with delayed surgery, and new complications from gallstones. DESIGN Retrospective multicentre cohort study. SETTING 3 hospitals in Sweden, covering 675 000 inhabitants. PARTICIPANTS 1634 patients with cholecystitis. OUTCOMES The incidence, treatment choice and diagnostic and treatment delay were investigated by comparing prepandemic and pandemic patients. RESULTS Patients diagnosed with cholecystitis during the pandemic were more comorbid (American Society of Anesthesiologists 2-5, 86% vs 81%, p=0.01) and more often had a diagnostic CT (67% vs 59%, p=0.01). There were variations in the number of patients corresponding with the pandemic waves, but there was no overall increase in the number of patients with cholecystitis (78 vs 76 cases/100 000 inhabitants, p=0.7) or the proportion of patients treated with surgery during the pandemic (50% vs 50%, p=0.4). There was no increase in time to admission from symptoms (both median 1 day, p=0.7), or surgery from admission (both median 1 day, p=0.9). The proportion of grades 2-3 cholecystitis was not higher during the pandemic (46% vs 44%, p=0.9). The median time to elective surgery increased (184 days vs 130 days, p=0.04), but there was no increase in new gallstone complications (35% vs 39%, p=0.3). CONCLUSION Emergency surgery for cholecystitis was not impacted by the pandemic in Sweden. Patients were more comorbid but did not have more severe cholecystitis nor was there a delay in seeking care. Fewer patients non-operatively managed had elective surgery within 6 months of their initial diagnosis but there was no corresponding increase in gallstone complications.
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Affiliation(s)
- Erik Osterman
- CKF Gävleborg, Uppsala University, Gävle, Sweden
- Department of Surgery, Gävle Sjukhus, Gävle, Sweden
| | - Sofia Jakobsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Fredrik Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
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Gomez D, Stukel TA, Baxter NN, Acuna SA, Wilton AS, Treleaven D, Ordon M, Kim SJ. A Population-Based Analysis of the Impact of the COVID-19 Pandemic on Solid Organ Transplantation in Ontario, Canada: Policy Response and Changes in Volume and 90-Day Outcomes. ANNALS OF SURGERY OPEN 2023; 4:e230. [PMID: 37600867 PMCID: PMC10431431 DOI: 10.1097/as9.0000000000000230] [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: 04/28/2022] [Accepted: 11/04/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives To evaluate the impact of the COVID-19 pandemic on solid organ transplantation. Background COVID-19 caused unprecedented disruption to solid organ transplantation (kidney, liver, heart, lung). Concerns about safety and decreases in deceased donors due to pandemic lockdowns have been described as potential causes. Methods We report population-based rates of transplantation during the first 3 waves of COVID-19 in Ontario, Canada (March 1, 2020-July 3, 2021) versus a pre-COVID-19 baseline period (January 1, 2017-February 29, 2020). Poisson models were used to predict transplantation rates during COVID-19, based on pre-COVID-19 rates, and generate observed to expected rate ratios (RRs). Ninety-day transplant outcomes (mortality, retransplantation, transplant nephrectomy) were captured. Results A 34.4% decrease (RR, 0.656; 95% confidence interval [CI], 0.586-0.734) in transplant rates was observed, coinciding with wave 1 and the deployment of a provincial transplant triaging system. Transplants decreased by 14.6% in wave 2 (RR, 0.854; 95% CI, 0.770-0.947) and 23.1% in wave 3 (RR, 0.769; 95% CI, 0.690-0.857) despite the triaging system not being activated. Overall, there was a 24.3% decrease (RR, 0.757; 95% CI, 0.679-0.844) in transplant rates, equivalent to 409 fewer transplants. No sustained changes were observed in heart or liver but sustained and large decreases were seen for lung (RR, 0.664; 95% CI, 0.482-0.915) and kidney (RR, 0.721; 95% CI, 0.602-0.863) transplantation. A low prevalence (1.7%) of COVID-19 infection within 90 days of transplantation was seen. No differences were observed in other 90-day outcomes. Conclusions Early safety concerns limited transplantation to immediate life-saving procedures; however, the reductions in kidney and lung transplants continued for the rest of the pandemic, where no restrictions were in place.
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Affiliation(s)
- David Gomez
- From the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Therese A. Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy N. Baxter
- From the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sergio A. Acuna
- From the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Darin Treleaven
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Trillium Gift of Life Network, Ontario Health, Toronto, ON, Canada
| | - Michael Ordon
- From the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - S. Joseph Kim
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto and the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Cochrun SL, Finnegan T, Kennedy GE, Garland M, Grams JM, Parmar AD. A retrospective single-institution review of the impact of COVID-19 on severity of biliary disease. Am J Surg 2023; 225:352-356. [PMID: 36243562 PMCID: PMC9513400 DOI: 10.1016/j.amjsurg.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic possessed far-reaching health implications beyond the public health impact that have yet to be fully elucidated. We hypothesized that the COVID-19 pandemic led to an increase in biliary disease complexity and incidence of emergency cholecystectomy. METHODS We reviewed our institutional experience with cholecystectomy from February 2019-February 2021, n = 912. Pre COVID-19 pandemic patients were compared to patients after the onset of the pandemic. Baseline characteristics were compared between groups. A Cochran-Armitage test for trend assessed the temporal impact of COVID-19 on emergency presentation and gallbladder disease complexity. RESULTS We identified 442 patients pre-pandemic and 470 patients during the pandemic. No significant differences were noted in demographics. COVID-19 significantly impacted emergency presentation (43.2% vs. 56.8%, p= <0.01), cholecystitis (53.2% vs 61.8%; p=<0.01), and gangrenous cholecystitis (2.8% vs 6.1%; p=<0.01). Both groups had similar clinical outcomes. CONCLUSIONS The COVID-19 pandemic affected an increased incidence of emergency presentation and complexity of gallbladder disease but did not significantly impact clinical outcomes. These findings may have broader implications for other diseases possibly affected by COVID-19.
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Affiliation(s)
- Steven L Cochrun
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Timothy Finnegan
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grace E Kennedy
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mason Garland
- Department of Surgery, Mercer University School of Medicine, Macon, GA, USA
| | - Jayleen M Grams
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abhishek D Parmar
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Factors Potential Patients Deem Important for Decision-Making in High-Risk Surgical Scenarios. J Am Coll Surg 2023; 236:93-98. [PMID: 36519912 DOI: 10.1097/xcs.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical futility and shared decision-making to proceed with high-risk surgery are challenging for patients and surgeons alike. It is unknown which factors contribute to a patient's decision to undergo high-risk and potentially futile surgery. The clinical perspective, founded in statistical probabilities of survival, could be misaligned with a patient's determination of worthwhile surgery. This study assesses factors most important to patients in pursuing high-risk surgery. STUDY DESIGN Via anonymous survey, lay participants recruited through Amazon's Mturk were presented high-risk scenarios necessitating emergency surgery. They rated factors (objective risk and quality-of-life domains) in surgical decision-making (0 = not at all, 4 = extremely) and made the decision to pursue surgery based on clinical scenarios. Repeated observations were accounted for via a generalized mixed-effects model and estimated effects of respondent characteristics, scenario factors, and likelihood to recommend surgery. RESULTS Two hundred thirty-six participants completed the survey. Chance of survival to justify surgery averaged 69.3% (SD = 21.3), ranking as the highest determining factor in electing for surgery. Other factors were also considered important in electing for surgery, including the average number of days the patient lived if surgery were and were not completed, functional and pain status after surgery, family member approval, and surgery cost. Postoperative independence was associated with proceeding with surgery (p < 0.001). Recommendations by patient age was moderated by respondent age (p = 0.002). CONCLUSION Patients highly value likelihood of survival and postoperative independence in shared decision-making for high-risk surgery. It is important to improve the understanding of surgical futility from a patient's perspective.
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Ross SW, McCartt JC, Cunningham KW, Reinke CE, Thompson KJ, Green JM, Thomas BW, Jacobs DG, May AK, Christmas AB, Sing RF. Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center. Am J Surg 2022; 224:1409-1416. [PMID: 36372581 PMCID: PMC9575313 DOI: 10.1016/j.amjsurg.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the COVID-19 pandemic on volume and outcomes of Acute Care Surgery patients, and we hypothesized that inpatient mortality would increase due to COVID+ and resource constraints. METHODS An American College of Surgeons verified Level I Trauma Center's trauma and operative emergency general surgery (EGS) registries were queried for all patients from Jan. 2019 to Dec. 2020. April 1st, 2020, was the demarcation date for pre- and during COVID pandemic. Primary outcome was inpatient mortality. RESULTS There were 14,460 trauma and 3091 EGS patients, and month-over-month volumes of both remained similar (p > 0.05). Blunt trauma decreased by 7.4% and penetrating increased by 31%, with a concomitant 25% increase in initial operative management (p < 0.001). Despite this, trauma (3.7%) and EGS (2.9-3.0%) mortality rates remained stable which was confirmed on multivariate analysis; p > 0.05. COVID + mortality was 8.8% and 3.7% in trauma and EGS patients, respectively. CONCLUSION Acute Care Surgeons provided high quality care to trauma and EGS patients during the pandemic without allowing excess mortality despite many hardships and resource constraints.
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Affiliation(s)
- Samuel W Ross
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Jason C McCartt
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Kyle W Cunningham
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Caroline E Reinke
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Kyle J Thompson
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - John M Green
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Bradley W Thomas
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - David G Jacobs
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Addison K May
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - A Britton Christmas
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Ronald F Sing
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA.
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Zhang Y, Diaz A, Kunnath N, Dimick JB, Scott JW, Ibrahim AM. Emergency Surgery Rates Among Medicare Beneficiaries With Access Sensitive Surgical Conditions. J Surg Res 2022; 279:755-764. [PMID: 35940052 DOI: 10.1016/j.jss.2022.06.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Access sensitive surgical conditions should be treated electively with optimal access but result in emergency operations when access is limited. However, the rates of emergency procedures for these conditions are unknown. METHODS Cross-sectional retrospective review of Medicare beneficiaries who underwent access sensitive surgical procedures (abdominal aortic aneurysm repair, colectomy for colorectal cancer, or incisional hernia repair) between 2014 and 2018. Risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, and Elixhauser comorbidities), hospital characteristics (ownership, size, geographic region, surgical volume) and type of operation were compared between planned and emergency (urgent and emergent) surgical procedures. Outcome measures were rates of emergency procedures as well as associated postoperative outcomes. RESULTS Of the 744,818 Medicare beneficiaries undergoing access sensitive surgical procedures, 259,541 (34.9%) were done in the emergency setting. Risk-adjusted rates of emergency surgery varied widely across hospital service areas from 23.28% (lowest decile) to 54.88% (highest decile) (Odds Ratio 4.74; P < 0.001). Emergency procedures were associated with significantly higher rates of 30-d mortality (8.15% versus 3.65%, P < 0.001) and readmissions (16.28% versus 12.88%, P < 0.001) compared to elective procedures. Sensitivity analysis with younger and healthier beneficiaries demonstrated persistently high rates (23.3%) of emergency surgery with wide regional variation and worse patient outcomes. CONCLUSIONS Emergency surgery for access sensitive surgical conditions is extremely common and varied almost fivefold across United States hospital service areas. This suggests there are opportunities to improve access for these common surgical conditions.
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Affiliation(s)
- Yuqi Zhang
- National Clinician Scholars Program at the Clinical Research Training Program, Duke University, Durham, North Carolina; Department of Surgery, Yale University, New Haven, Connecticut.
| | - Adrian Diaz
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Nicholas Kunnath
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
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Rosen S, Phillips S, Gupta A, Pierce R. The Impact of the COVID-19 Pandemic on Sociodemographic Disparities in Rates of Elective Hernia Surgeries. Am Surg 2022; 88:1452-1458. [PMID: 35337192 PMCID: PMC8960748 DOI: 10.1177/00031348221082273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The global pandemic has shed light on the role of health care disparities; however, little data exists to determine how COVID-19 affected access to elective surgical care. We aimed to determine the impact of health care disparities and surgical care for patients undergoing hernia surgery across a national quality collaborative database. MATERIALS AND METHODS All patients undergoing elective hernia surgery between March 2018 and April 2021 were identified within the Abdominal Core Health Quality Collaborative. Patients were divided based on date of surgery into pre-, post-, and COVID-19 spike groups. Descriptive statistics were calculated for comorbidities, demographics, surgical location, Distressed Community Index (DCI), and hernia characteristics stratified by period of surgery. Rates and chi-squared test were used for categorical variables. Median, IQR, and Wilcoxon test were used continuous variables. RESULTS 35 149 patients met inclusion criteria. Pre-COVID-19, COVID-19 spike, and post-COVID-19 groups showed no significant difference in mean age or the proportion of patients in each DCI variable. Proportionately fewer females and more White non-Hispanic patients were operated on during the COVID-19 spike. Surgeons affiliated with academic hospitals saw proportionality fewer elective cases during the COVID-19 spike. DISCUSSION This study suggests white males with private hospital affiliation were more likely to have elective hernia surgery during the COVID-19 spike, however these trends were not associated with health care DCI changes during the same period. Further study is necessary to determine the reasons for these differences and will be important to optimize surgical care for patients during a worldwide pandemic.
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Affiliation(s)
- Samantha Rosen
- Department of Surgery, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon Phillips
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anand Gupta
- Department of Surgery, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard Pierce
- Department of Surgery, 5718Vanderbilt University Medical Center, Nashville, TN, USA
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Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis. World J Surg 2022; 46:984-993. [PMID: 35267077 PMCID: PMC8908743 DOI: 10.1007/s00268-022-06503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
Background The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. Methods Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. Results 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). Conclusions During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06503-2.
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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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