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Observational Study
. 2021 Jun 18;16(6):e0252919.
doi: 10.1371/journal.pone.0252919. eCollection 2021.

Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis

Amelia J Hessheimer  1 , Marta Trapero-Bertran  2 , Alex Borin  3 , Eugenia Butori  3   4 , Anna Curell  4 , Arlena Sofía Espinoza  3   4 , Joaquín Jensen  3 , Víctor Turrado  4 , Xavier Morales  4 , Antonio María de Lacy  4 , Constantino Fondevila  1
Affiliations
Observational Study

Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis

Amelia J Hessheimer et al. PLoS One. .

Abstract

Background: Over the course of the COVID19 pandemic, global healthcare delivery has declined. Surgery is one of the most resource-intensive area of medicine; loss of surgical care has had untold health and economic consequences. Herein, we evaluate resource utilization, outcomes, and healthcare costs associated with unplanned surgery admissions during the height of the pandemic in 2020 versus the same period in 2019.

Methods: Retrospective analysis on patients ≥18 years admitted from the emergency department to General & Digestive and Gastrointestinal Surgery Services between February and May 2019 and 2020 at our center; clinical outcomes and unadjusted and adjusted per-person healthcare costs were analyzed.

Results: Consults and admissions to surgery declined between February and May 2020 by 37% and 19%, respectively, relative to the same period in 2019, with even greater relative decline during late March and early April. Time between onset of symptoms to diagnosis increased from 2±3 days 2019 to 5±22 days 2020 (P = 0.01). Overall hospital stay was two days less in 2020 (P = 0.19). Complications (Comprehensive Complication Index 10.3±23.7 2019 vs. 13.9±25.5 2020, P = 0.10) and mortality rates (3% vs. 4%, respectively, P = 0.58) did not vary. Mean unadjusted per-person costs for patients in the 2019 and 2020 cohorts were 5,886.72€±12,576.33€ and 5,287.62±7,220.16€, respectively (P = 0.43). Following multivariate analysis, costs remained similar (4,656.89€±390.53€ 2019 vs. 4,938.54±406.55€ 2020, P = 0.28).

Conclusions: Healthcare delivery and spending for unplanned general surgery admissions declined considerably due to COVID19. These results provide a small yet relevant illustration of clinical and economic ramifications of this healthcare crisis.

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Conflict of interest statement

Amelia J. Hessheimer and Constantino Fondevila have received consultancy fees from Guanguong Shunde Innovative Design Institute, Guangdong, China, and research funding from Instituto de Salud Carlos III. This does not alter their adherence to PLOS ONE policies on sharing data and materials. The remainder of authors have no disclosures.

Figures

Fig 1
Fig 1. Emergency surgery consults and admissions.
Monthly evolution of unplanned general surgery consults and admissions during two periods: 02-05/2019 (pre-pandemic) and 02-05/2020 (COVID19 pandemic).
Fig 2
Fig 2. Costs for emergency general surgery admissions.
Monthly evolution of total per-person healthcare costs for unplanned general surgery admissions during two periods: 02-05/2019 (pre-pandemic) and 02-05/2020 (COVID19 pandemic).
See this image and copyright information in PMC

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