Reduced Rate of Inpatient Hospital Admissions in 18 German University Hospitals During the COVID-19 Lockdown

Abstract

The COVID-19 pandemic has caused strains on health systems worldwide disrupting routine hospital services for all non-COVID patients. Within this retrospective study, we analyzed inpatient hospital admissions across 18 German university hospitals during the 2020 lockdown period compared to 2018. Patients admitted to hospital between January 1 and May 31, 2020 and the corresponding periods in 2018 and 2019 were included in this study. Data derived from electronic health records were collected and analyzed using the data integration center infrastructure implemented in the university hospitals that are part of the four consortia funded by the German Medical Informatics Initiative. Admissions were grouped and counted by ICD 10 chapters and specific reasons for treatment at each site. Pooled aggregated data were centrally analyzed with descriptive statistics to compare absolute and relative differences between time periods of different years. The results illustrate how care process adoptions depended on the COVID-19 epidemiological situation and the criticality of the disease. Overall inpatient hospital admissions decreased by 35% in weeks 1 to 4 and by 30.3% in weeks 5 to 8 after the lockdown announcement compared to 2018. Even hospital admissions for critical care conditions such as malignant cancer treatments were reduced. We also noted a high reduction of emergency admissions such as myocardial infarction (38.7%), whereas the reduction in stroke admissions was smaller (19.6%). In contrast, we observed a considerable reduction in admissions for non-critical clinical situations, such as hysterectomies for benign tumors (78.8%) and hip replacements due to arthrosis (82.4%). In summary, our study shows that the university hospital admission rates in Germany were substantially reduced following the national COVID-19 lockdown. These included critical care or emergency conditions in which deferral is expected to impair clinical outcomes. Future studies are needed to delineate how appropriate medical care of critically ill patients can be maintained during a pandemic.

Keywords: COVID-19; Germany; healthcare systems; inpatient hospital admissions; lockdown; medical informatics initiative; pandemic; university hospitals.

Figure 1

Inpatient hospital admissions in 2018, 2019, and 2020. Line chart of the cumulative hospital admissions per week across the 18 participating university hospitals. The curves are aligned for Easter holidays as outlined above. Vertical lines (gray) mark adjusted weeks 0, 3, 4 and 7, respectively.

Figure 2

Inpatient hospital admissions related to myocardial infarction and stroke. Line chart of the cumulative hospital admissions per week related to myocardial infarction (left) and stroke (right) across the 18 participating university hospitals. The curves are aligned for Easter holidays as outlined above. Vertical lines (gray) mark adjusted weeks 0, 3, 4 and 7, respectively.

Figure 3

Inpatient hospital admissions related to endoprosthesis implants. Line chart of the cumulative hospital admissions per week related to endoprosthesis implants due to arthrosis (left) and due to hip fracture (right) across the 18 participating university hospitals. The curves are aligned for Easter holidays as outlined above. Vertical lines (gray) mark adjusted weeks 0, 3, 4, and 7, respectively.

Figure 4

Inpatient hospital admissions related to lung cancer and brain tumor (malignant) related surgeries. Line chart of the cumulative hospital admissions per week related to lung cancer related surgeries (left) and due to (malignant) brain tumor related surgeries (right) across the 18 participating university hospitals. The curves are aligned for Easter holidays as outlined above. Vertical lines (gray) mark adjusted weeks 0, 3, 4, and 7, respectively.

Figure 5

Inpatient hospital admissions related to hysterectomies. Line chart of the cumulative hospital admissions per week related to hysterectomies in case of benign tumors (left) and due to hysterectomies of malignant tumors (right) across the 18 participating university hospitals. The curves are aligned for Easter holidays as outlined above. Vertical lines (gray) mark adjusted weeks 0, 3, 4, and 7, respectively.