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. 2022 Jun 28;16(1):22.
doi: 10.1186/s13037-022-00331-y.

Impact of the COVID-19 pandemic on delays in surgical procedures in Germany: a multi-center analysis of an administrative registry of 176,783 patients

Richard Hunger  1 , Volker König  2 , Rosi Stillger  2 , René Mantke  3   4
Affiliations

Impact of the COVID-19 pandemic on delays in surgical procedures in Germany: a multi-center analysis of an administrative registry of 176,783 patients

Richard Hunger et al. Patient Saf Surg. .

Abstract

Background: While extensive data are available on the postponement of elective surgical procedures due to the COVID-19 pandemic for Germany, data on the impact on emergency procedures is limited.

Methods: In this retrospective case-control study, anonymized case-related routine data of a Germany-wide voluntary hospital association (CLINOTEL association) of 66 hospitals was analyzed. Operation volumes, in-hospital mortality, and COVID-19 prevalence rates in digestive surgery procedure groups and selected single surgical procedures in the one-year periods before and after the outbreak of the COVID-19 pandemic were analyzed. The analysis was stratified by admitting department (direct admission or transfer to the general surgical department, i.e., primary or secondary surgical patients) and type of admission (elective/emergent).

Results: The total number of primary and secondary surgical patients decreased by 22.7% and 11.7%, respectively. Among primary surgical patients more pronounced reductions were observed in elective (-25.6%) than emergency cases (-18.8%). Most affected procedures were thyroidectomies (-30.2%), operations on the anus (-24.2%), and closure of abdominal hernias (-23.9%; all P's < 0.001). Declines were also observed in colorectal (-9.0%, P = 0.002), but not in rectal cancer surgery (-3.9%, n.s.). Mortality was slightly increased in primary (1.3 vs. 1.5%, P < 0.001), but not in secondary surgical cases. The one-year prevalence of COVID-19 in general surgical patients was low (0.6%), but a significant driver of mortality (OR = 9.63, P < 0.001).

Conclusions: Compared to the previous year period, the number of patients in general and visceral surgery decreased by 22.7% in the first pandemic year. At the procedure level, a decrease of 14.8% was observed for elective procedures and 6.0% for emergency procedures. COVID-19 infections in general surgical patients are rare (0.6% prevalence), but associated with high mortality (21.8%).

Trial registration: The present study does not meet the ICMJE definition of a clinical trial and was therefore not registered.

Keywords: COVID-19; Elective surgery; Emergent surgery; General surgery; Health care research.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Graphical presentation of assessed patient groups. Note. Blue numbered ellipses indicate analyzed patient groups. Visceral surgery procedures include all procedures performed on the digestive tract. Selected procedures encompass thyroidectomy, appendectomy, cholecystectomy, as well as colon resections and rectum resection for cancer. For further details see text
Fig. 2
Fig. 2
Case volume differences and distribution across patient groups. Note. Case volume differences between the two observation periods (03/2019–02/2020 vs. 03/2020–02/2021) stratified by primary/secondary patients (direct admission to surgical department and transferred from other departments, respectively) and admission type. Black dot and whiskers indicate overall case volume change and 95% confidence intervals. Stacked bar charts show the relative case volume change for the different patient groups. Bars right to the black line indicate an increased case volume. NPeriod 1 = 95,826. NPeriod 2 = 80,957
Fig. 3
Fig. 3
Mortality stratified by procedure group and COVID-19 infection status. Note. Mortality rates in the second observation period (03/2020–02/2021) across all digestive surgery patients stratified by procedure group and COVID-19 infection status. Black whiskers indicate 95% confidence intervals. P values indicate the results of chi-square tests comparing mortality rates between subgroups. Nno COVID-19 = 80,444. NCOVID-19 = 513
Fig. 4
Fig. 4
COVID-19 prevalence stratified by procedure and admission type. Note. Proportion of patients with concomitant COVID-19 infection (point estimate and 95% confidence interval) in digestive surgery (A) and selected procedures (B) stratified by admission type. Combined analysis of primary and secondary surgical cases. Varying N, see Table 1 for further details
See this image and copyright information in PMC

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