Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland – A Retrospective Study Based on Insurance Claims Data

Document Type : Original Article

Authors

1 Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland

2 Division of Cardiology, Cantonal Hospital Graubuenden, Chur, Switzerland

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.

Keywords

Main Subjects

References

  1. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107(11):1440-1449. doi:1002/bjs.11746
  2. Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood). 2020;39(11):2010-2017. doi:1377/hlthaff.2020.00980
  3. Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. doi:1136/bmjopen-2020-045343
  4. Roy CM, Bollman EB, Carson LM, Northrop AJ, Jackson EF, Moresky RT. Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review. Eur J Public Health. 2021;31(3):634-640. doi:1093/eurpub/ckab047
  5. Xiao H, Dai X, Wagenaar BH, et al. The impact of the COVID-19 pandemic on health services utilization in China: time-series analyses for 2016-2020. Lancet Reg Health West Pac. 2021;9:100122. doi:1016/j.lanwpc.2021.100122
  6. Williams R, Jenkins DA, Ashcroft DM, et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. Lancet Public Health. 2020;5(10):e543-e550. doi:1016/s2468-2667(20)30201-2
  7. Federal Assembly of the Swiss Confederation. [COVID-19 regulation 2]. Vol Art. 10a. Bern, Switzerland: Federal Office of Public Health; 2020.
  8. De Rosa S, Spaccarotella C, Basso C, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41(22):2083-2088. doi:1093/eurheartj/ehaa409
  9. Solomon MD, McNulty EJ, Rana JS, et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020;383(7):691-693. doi:1056/NEJMc2015630
  10. Hoyer C, Ebert A, Huttner HB, et al. Acute stroke in times of the COVID-19 pandemic: a multicenter study. Stroke. 2020;51(7):2224-2227. doi:1161/strokeaha.120.030395
  11. Seiffert M, Brunner FJ, Remmel M, et al. Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims. Clin Res Cardiol. 2020;109(12):1540-1548. doi:1007/s00392-020-01723-9
  12. Federal Office of Public Health. COVID-19 Switzerland: Information on the Current Situation. https://www.covid19.admin.ch/en/overview. Accessed September 17, 2021.
  13. Rachamin Y, Senn O, Streit S, Dubois J, Deml MJ, Jungo KT. Impact of the COVID-19 pandemic on the intensity of health services use in general practice: a retrospective cohort study. Int J Public Health. 2021;66:635508. doi:3389/ijph.2021.635508
  14. Seidu S, Kunutsor SK, Cos X, Khunti K. Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: a systematic review. Prim Care Diabetes. 2021;15(4):653-681. doi:1016/j.pcd.2021.05.011
  15. Hajdu SD, Pittet V, Puccinelli F, et al. Acute stroke management during the COVID-19 pandemic: does confinement impact eligibility for endovascular therapy? Stroke. 2020;51(8):2593-2596. doi:1161/strokeaha.120.030794
  16. Riera R, Bagattini  M, Pacheco RL, Pachito DV, Roitberg F, Ilbawi A. Delays and disruptions in cancer health care due to COVID-19 pandemic: systematic review. JCO Glob Oncol. 2021;7:311-323. doi:1200/go.20.00639
  17. Rocco N, Montagna G, Di Micco R, et al. The impact of the COVID-19 pandemic on surgical management of breast cancer: global trends and future perspectives. Oncologist. 2021;26(1):e66-e77. doi:1002/onco.13560
  18. Federal Assembly of the Swiss Confederation. Federal Act on Data Protection (FADP). Vol Art. 22.
  19. Federal Office of Public Health. Health Insurance. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung.html. Accessed September 7, 2021.
  20. Federal Office of Public Health. Hospital Treatment. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Spitalbehandlung.html. Accessed September 7, 2021.
  21. Federal Office of Public Health. Inpatient tariff structures. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Spitalbehandlung/Tarifsystem-SwissDRG.html. Accessed September 7, 2021.
  22. Federal Office of Public Health. Statistics on Compulsory Health Insurance.
  23. Federal Statistical Office. Swiss Surgical Classification, CHOP. https://www.bfs.admin.ch/bfs/en/home/statistics/catalogues-databases/publications.assetdetail.5808569.html. Accessed September 7, 2021.
  24. World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems (ICD). https://www.who.int/classifications/classification-of-diseases. Accessed September 7, 2021.
  25. Zimmermann BM, Fiske A, McLennan S, Sierawska A, Hangel N, Buyx A. Motivations and limits for COVID-19 policy compliance in Germany and Switzerland. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.30
  26. Pleninger R, Streicher S, Sturm JE. Do COVID-19 containment measures work? Evidence from Switzerland. Swiss J Econ Stat. 2022;158(1):5. doi:1186/s41937-022-00083-7
  27. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2019.
  28. Gomez D, Dossa F, Sue-Chue-Lam C, et al. Impact of COVID 19 on the provision of surgical services in Ontario, Canada: population-based analysis. Br J Surg. 2021;108(1):e15-e17. doi:1093/bjs/znaa043
  29. Kwok CS, Gale CP, Curzen N, et al. Impact of the COVID-19 pandemic on percutaneous coronary intervention in England: insights from the British Cardiovascular Intervention Society PCI database cohort. Circ Cardiovasc Interv. 2020;13(11):e009654. doi:1161/circinterventions.120.009654
  30. Mouawad NJ, Woo K, Malgor RD, et al. The impact of the COVID-19 pandemic on vascular surgery practice in the United States. J Vasc Surg. 2021;73(3):772-779.e774. doi:1016/j.jvs.2020.08.036
  31. Thaler M, Khosravi I, Hirschmann MT, et al. Disruption of joint arthroplasty services in Europe during the COVID-19 pandemic: an online survey within the European Hip Society (EHS) and the European Knee Associates (EKA). Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1712-1719. doi:1007/s00167-020-06033-1
  32. Liebensteiner MC, Khosravi I, Hirschmann MT, Heuberer PR, Thaler M. Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1705-1711. doi:1007/s00167-020-06032-2
  33. Hübner M, Zingg T, Martin D, Eckert P, Demartines N. Surgery for non-COVID-19 patients during the pandemic. PLoS One. 2020;15(10):e0241331. doi:1371/journal.pone.0241331
  34. Baugh JJ, White BA, McEvoy D, et al. The cases not seen: patterns of emergency department visits and procedures in the era of COVID-19. Am J Emerg Med. 2021;46:476-481. doi:1016/j.ajem.2020.10.081
  35. McLean RC, Young J, Musbahi A, et al. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: is there a "lockdown" effect? Int J Surg. 2020;83:259-266. doi:1016/j.ijsu.2020.09.011
  36. Riley JS, Luks VL, de Pina LF, et al. COVID-19 pandemic significantly decreases acute surgical complaints. Am Surg. 2020;86(11):1492-1500. doi:1177/0003134820949506
  37. Fahrner R, Bähler S, Lindner G. COVID-19 lock-down significantly reduced number of surgical presentations in an emergency department. Wien Klin Wochenschr. 2021;133(7-8):399-402. doi:1007/s00508-021-01810-5
  38. Hung KK, Walline JH, Chan EYY, et al. Health service utilization in Hong Kong during the COVID-19 pandemic - a cross-sectional public survey. Int J Health Policy Manag. 2022;11(4):508-513. doi:34172/ijhpm.2020.183
  39. Basis F, Zeidani H, Hussein K, Hareli S. Drastic reduction inpatient visits to the emergency department in a hospital in Israel during the COVID-19 outbreak, compared to the H1N1 2009. Int J Health Policy Manag. 2022;11(4):429-433. doi:34172/ijhpm.2020.151
  40. Deml MJ, Minnema J, Dubois J, et al. The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: a mixed-methods study. Soc Sci Med. 2022;298:114858. doi:1016/j.socscimed.2022.114858
  41. Wyatt S, Mohammed MA, Fisher E, McConkey R, Spilsbury P. Impact of the SARS-CoV-2 pandemic and associated lockdown measures on attendances at emergency departments in English hospitals: a retrospective database study. Lancet Reg Health Eur. 2021;2:100034. doi:1016/j.lanepe.2021.100034
  42. Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75(22):2871-2872. doi:1016/j.jacc.2020.04.011
  43. Huynh J, Barmano N, Karlsson JE, Stomby A. Sex and age differences in the incidence of acute myocardial infarction during the COVID-19 pandemic in a Swedish health-care region without lockdown: a retrospective cohort study. Lancet Healthy Longev. 2021;2(5):e283-e289. doi:1016/s2666-7568(21)00085-4
  44. Kansagra AP, Goyal MS, Hamilton S, Albers GW. Collateral effect of COVID-19 on stroke evaluation in the United States. N Engl J Med. 2020;383(4):400-401. doi:1056/NEJMc2014816
  45. Nogueira RG, Qureshi MM, Abdalkader M, et al. Global impact of COVID-19 on stroke care and IV thrombolysis. Neurology. 2021;96(23):e2824-e2838. doi:1212/WNL.0000000000011885
  46. Campo G, Fortuna D, Berti E, et al. In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: a population-based observational study. Lancet Reg Health Eur. 2021;3:100055. doi:1016/j.lanepe.2021.100055
  47. Van Belle E, Manigold T, Piérache A, et al. Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: an observational study. Lancet Reg Health Eur. 2021;2:100030. doi:1016/j.lanepe.2021.100030
  48. Kwok CS, Gale CP, Kinnaird T, et al. Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction. Heart. 2020;106(23):1805-1811. doi:1136/heartjnl-2020-317650
  49. Rodriguez-Leor O, Cid-Álvarez B, Ojeda S, et al. Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. REC Interv Cardiol. 2020;2(2):82-89.
  50. Bähler C, Elmiger M, Signorell A. Helsana-Report: Corona. 2021. http://reports.helsana.ch/corona/. Accessed September 17, 2021.
  51. Ryffel C, Lanz J, Corpataux N, et al. Mortality, stroke, and hospitalization associated with deferred vs expedited aortic valve replacement in patients referred for symptomatic severe aortic stenosis during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2020402. doi:1001/jamanetworkopen.2020.20402
  52. Butt JH, Fosbøl EL, Gerds TA, et al. All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study. Eur Heart J. 2021;42(15):1516-1523. doi:1093/eurheartj/ehab028
  53. Aguiar S, Riechelmann RP, de Mello CAL, et al. Impact of COVID-19 on colorectal cancer presentation. Br J Surg. 2021;108(2):e81-e82. doi:1093/bjs/znaa124
  54. Diamand R, Ploussard G, Roumiguié M, et al. Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic. World J Urol. 2021;39(6):1789-1796. doi:1007/s00345-020-03402-w
  55. Moreno R, Díez JL, Diarte JA, et al. Consequences of canceling elective invasive cardiac procedures during COVID-19 outbreak. Catheter Cardiovasc Interv. 2021;97(5):927-937. doi:1002/ccd.29433
  56. COVIDSurg Collaborative, GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2021;76(6):748-758. doi:1111/anae.15458
  57. Liebensteiner MC, Khosravi I, Hirschmann MT, Heuberer PR, Saffarini M, Thaler M. It is not 'business as usual' for orthopaedic surgeons in May 2020- the Austrian-German-Swiss experience. J Exp Orthop. 2020;7(1):61. doi:1186/s40634-020-00272-4
  58. Bose SK, Dasani S, Roberts SE, et al. The cost of quarantine: projecting the financial impact of canceled elective surgery on the nation's hospitals. Ann Surg. 2021;273(5):844-849. doi:1097/sla.0000000000004766
  59. Tonna JE, Hanson HA, Cohan JN, et al. Balancing revenue generation with capacity generation: case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19. BMC Health Serv Res. 2020;20(1):1119. doi:1186/s12913-020-05975-z
  60. Moynihan R, Johansson M, Maybee A, Lang E, Légaré F. COVID-19: an opportunity to reduce unnecessary healthcare. BMJ. 2020;370:m2752. doi:1136/bmj.m2752
  61. Sorenson C, Japinga M, Crook H, McClellan M. Building a better health care system post-COVID-19: steps for reducing low-value and Wasteful care. NEJM Catal Innov Care Deliv. 2020;1(4):1-10. doi:1056/cat.20.0368
  62. Brüngger B, Bähler C, Schwenkglenks M, et al. Surgical procedures in inpatient versus outpatient settings and its potential impact on follow-up costs. Health Policy. 2021;125(10):1351-1358. doi:1016/j.healthpol.2021.07.006

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History

  • Receive Date: 10 November 2021
  • Revise Date: 05 June 2022
  • Accept Date: 14 August 2022
  • First Publish Date: 15 August 2022

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