. 2022 Nov 22;109(12):1282-1292.

doi: 10.1093/bjs/znac301.

Impact of the COVID-19 pandemic on surgical care in the Netherlands

Michelle R de Graaff^{1

2

3

4}, Rianne N M Hogenbirk¹, Yester F Janssen¹, Arthur K E Elfrink⁵, Ronald S L Liem^{6

7}, Simon W Nienhuijs⁸, Jean-Paul P M de Vries¹, Jan-Willem Elshof⁹, Emiel Verdaasdonk¹⁰, Jarno Melenhorst³, H L van Westreenen¹¹, Marc G H Besselink^{12

13}, Jelle P Ruurda¹⁴, Mark I van Berge Henegouwen¹², Joost M Klaase¹, Marcel den Dulk³, Mark van Heijl¹⁵, Johannes H Hegeman¹⁶, Jerry Braun¹⁷, Daan M Voeten^{2

5}, Franka S Würdemann^{2

17}, Anne-Loes K Warps^{2

17}, Anna J Alberga^{2

18}, J Annelie Suurmeijer^{2

12

13}, Erman O Akpinar^{2

3}, Nienke Wolfhagen^{2

19}, Anne Loes van den Boom¹, Marieke J Bolster-van Eenennaam⁴, Peter van Duijvendijk⁴, David J Heineman⁵, Michel W J M Wouters^{2

20

21}, Schelto Kruijff¹; Dutch CovidSurg Collaborative Study Group

Collaborators, Affiliations

Collaborators

Dutch CovidSurg Collaborative Study Group:
J N Helleman, C L Koningswoud-Terhoeve, E Belt, J A B van der Hoeven, G M H Marres, F Tozzi, E M von Meyenfeldt, R R J Coebergh-van den Braak, S Huisman, A M Rijken, R Balm, F Daams, C Dickhoff, W J Eshuis, S S Gisbertz, H R Zandbergen, K J Hartemink, S A Keessen, N F M Kok, K F D Kuhlmann, J W van Sandick, A A Veenhof, A Wals, M S van Diepen, L Schoonderwoerd, C T Stevens, D Susa, B L W Bendermacher, N Olofsen, M van Himbeeck, I H J T de Hingh, H J B Janssen, M D P Luyer, G A P Nieuwenhuijzen, M Ramaekers, R Stacie, A K Talsma, M W Tissink, D Dolmans, R Berendsen, J Heisterkamp, W A Jansen, M de Kort-van Oudheusden, R M Matthijsen, D J Grünhagen, S M Lagarde, A P W M Maat, P C van der Sluis, R B Waalboer, V Brehm, J P van Brussel, M Morak, E D Ponfoort, J E M Sybrandy, P L Klemm, W Lastdrager, H W Palamba, S M van Aalten, L N L Tseng, K E A van der Bogt, W J de Jong, J W A Oosterhuis, Q Tummers, G M van der Wilden, S Ooms, E H Pasveer, H T C Veger, M J Molegraafb, V B Nieuwenhuijs, G A Patijn, M E V van der Veldt, D Boersma, S T W van Haelst, I D van Koeverden, M L Rots, B A Bonsing, N Michiels, O D Bijlstra, J Braun, D Broekhuis, H W Brummelaar, H H Hartgrink, A Metselaar, J S D Mieog, I B Schipper, W O de Steur, B Fioole, E C Terlouw, C Biesmans, J W A M Bosmans, S A W Bouwense, S H E M Clermonts, M M E Coolsen, B M E Mees, G W H Schurink, J W Duijff, T van Gent, L C F de Nes, D Toonen, M J Beverwijk, E van den Hoed, B Keizers, W Kelder, B P J A Keller, B B Pultrum, E van Rosum, A G Wijma, F van den Broek, W K G Leclercq, M J A Loos, J M L Sijmons, R H D Vaes, P J Vancoillie, E C J Consten, J M J Jongen, P M Verheijen, V van Weel, C H P Arts, J Jonker, G Murrmann-Boonstra, J P E N Pierie, J Swart, E B van Duyn, R H Geelkerken, R de Groot, N L Moekotte, A Stam, A Voshaar, G J D van Acker, R M A Bulder, D J Swank, I T A Pereboom, W H Hoffmann, M Orsini, J J Blok, J H P Lardenoije, M M P J Reijne, P van Schaik, L Smeets, S M M van Sterkenburg, N J Harlaar, S Mekke, T Verhaakt, E Cancrinus, G W van Lammeren, I Q Molenaar, H C van Santvoort, A W F Vos, A P Schouten-van der Velden, K Woensdregt, S P Mooy-Vermaat, D M Scharn, H A Marsman, F Rassam, F R Halfwerk, A J Andela, C I Buis, G M van Dam, K Ten Duis, B van Etten, L Lases, M Meerdink, V E de Meijer, B Pranger, S Ruiter, M Rurenga, A Wiersma, A R Wijsmuller, K I Albers, P B van den Boezem, B Klarenbeek, B M van der Kolk, C J H M van Laarhoven, E Matthée, N Peters, C Rosman, A M A Schroen, M W J Stommel, A F T M Verhagen, R van der Vijver, M C Warlé, J H W de Wilt, J W van den Berg, T Bloemert, G J de Borst, E H van Hattum, C E V B Hazenberg, J A van Herwaarden, R van Hillegerberg, T E Kroese, B J Petri, R J Toorop, F Aarts, R J L Janssen, S H P Janssen-Maessen, M Kool, H Verberght, D E Moes, J W Smit, A M Wiersema, B P Vierhout, B de Vos, F C den Boer, N A M Dekker, J M J Botman, M J van Det, E C Folbert, E de Jong, J C Koenen, E A Kouwenhoven, I Masselink, L H Navis, H J Belgers, M N Sosef, J H M B Stoot

Affiliations

¹ Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
² Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.
³ Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁴ Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
⁵ Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.
⁷ Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands.
⁸ Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
⁹ Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
¹⁰ Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.
¹¹ Department of Surgery, Isala, Zwolle, the Netherlands.
¹² Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
¹³ Cancer Centre Amsterdam, Amsterdam, the Netherlands.
¹⁴ Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
¹⁵ Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands.
¹⁶ Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands.
¹⁷ Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
¹⁸ Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
¹⁹ Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
²⁰ Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
²¹ Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.

PMID: 36811624
PMCID: PMC10364688
DOI: 10.1093/bjs/znac301

Impact of the COVID-19 pandemic on surgical care in the Netherlands

Michelle R de Graaff et al. Br J Surg. 2022.

. 2022 Nov 22;109(12):1282-1292.

doi: 10.1093/bjs/znac301.

Authors

Collaborators

Dutch CovidSurg Collaborative Study Group:
J N Helleman, C L Koningswoud-Terhoeve, E Belt, J A B van der Hoeven, G M H Marres, F Tozzi, E M von Meyenfeldt, R R J Coebergh-van den Braak, S Huisman, A M Rijken, R Balm, F Daams, C Dickhoff, W J Eshuis, S S Gisbertz, H R Zandbergen, K J Hartemink, S A Keessen, N F M Kok, K F D Kuhlmann, J W van Sandick, A A Veenhof, A Wals, M S van Diepen, L Schoonderwoerd, C T Stevens, D Susa, B L W Bendermacher, N Olofsen, M van Himbeeck, I H J T de Hingh, H J B Janssen, M D P Luyer, G A P Nieuwenhuijzen, M Ramaekers, R Stacie, A K Talsma, M W Tissink, D Dolmans, R Berendsen, J Heisterkamp, W A Jansen, M de Kort-van Oudheusden, R M Matthijsen, D J Grünhagen, S M Lagarde, A P W M Maat, P C van der Sluis, R B Waalboer, V Brehm, J P van Brussel, M Morak, E D Ponfoort, J E M Sybrandy, P L Klemm, W Lastdrager, H W Palamba, S M van Aalten, L N L Tseng, K E A van der Bogt, W J de Jong, J W A Oosterhuis, Q Tummers, G M van der Wilden, S Ooms, E H Pasveer, H T C Veger, M J Molegraafb, V B Nieuwenhuijs, G A Patijn, M E V van der Veldt, D Boersma, S T W van Haelst, I D van Koeverden, M L Rots, B A Bonsing, N Michiels, O D Bijlstra, J Braun, D Broekhuis, H W Brummelaar, H H Hartgrink, A Metselaar, J S D Mieog, I B Schipper, W O de Steur, B Fioole, E C Terlouw, C Biesmans, J W A M Bosmans, S A W Bouwense, S H E M Clermonts, M M E Coolsen, B M E Mees, G W H Schurink, J W Duijff, T van Gent, L C F de Nes, D Toonen, M J Beverwijk, E van den Hoed, B Keizers, W Kelder, B P J A Keller, B B Pultrum, E van Rosum, A G Wijma, F van den Broek, W K G Leclercq, M J A Loos, J M L Sijmons, R H D Vaes, P J Vancoillie, E C J Consten, J M J Jongen, P M Verheijen, V van Weel, C H P Arts, J Jonker, G Murrmann-Boonstra, J P E N Pierie, J Swart, E B van Duyn, R H Geelkerken, R de Groot, N L Moekotte, A Stam, A Voshaar, G J D van Acker, R M A Bulder, D J Swank, I T A Pereboom, W H Hoffmann, M Orsini, J J Blok, J H P Lardenoije, M M P J Reijne, P van Schaik, L Smeets, S M M van Sterkenburg, N J Harlaar, S Mekke, T Verhaakt, E Cancrinus, G W van Lammeren, I Q Molenaar, H C van Santvoort, A W F Vos, A P Schouten-van der Velden, K Woensdregt, S P Mooy-Vermaat, D M Scharn, H A Marsman, F Rassam, F R Halfwerk, A J Andela, C I Buis, G M van Dam, K Ten Duis, B van Etten, L Lases, M Meerdink, V E de Meijer, B Pranger, S Ruiter, M Rurenga, A Wiersma, A R Wijsmuller, K I Albers, P B van den Boezem, B Klarenbeek, B M van der Kolk, C J H M van Laarhoven, E Matthée, N Peters, C Rosman, A M A Schroen, M W J Stommel, A F T M Verhagen, R van der Vijver, M C Warlé, J H W de Wilt, J W van den Berg, T Bloemert, G J de Borst, E H van Hattum, C E V B Hazenberg, J A van Herwaarden, R van Hillegerberg, T E Kroese, B J Petri, R J Toorop, F Aarts, R J L Janssen, S H P Janssen-Maessen, M Kool, H Verberght, D E Moes, J W Smit, A M Wiersema, B P Vierhout, B de Vos, F C den Boer, N A M Dekker, J M J Botman, M J van Det, E C Folbert, E de Jong, J C Koenen, E A Kouwenhoven, I Masselink, L H Navis, H J Belgers, M N Sosef, J H M B Stoot

Affiliations

¹ Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
² Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.
³ Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁴ Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
⁵ Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.
⁷ Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands.
⁸ Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
⁹ Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
¹⁰ Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.
¹¹ Department of Surgery, Isala, Zwolle, the Netherlands.
¹² Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
¹³ Cancer Centre Amsterdam, Amsterdam, the Netherlands.
¹⁴ Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
¹⁵ Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands.
¹⁶ Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands.
¹⁷ Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
¹⁸ Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
¹⁹ Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
²⁰ Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
²¹ Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.

PMID: 36811624
PMCID: PMC10364688
DOI: 10.1093/bjs/znac301

Abstract

Background: The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.

Methods: A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.

Results: Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).

Conclusion: The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

Plain language summary

COVID-19 has had a significant impact on healthcare worldwide. Hospital visits were reduced, operating facilities were used for COVID-19 care, and cancer screening programmes were cancelled. This study describes the impact of the COVID-19 pandemic on Dutch surgical healthcare in 2020. Patterns of care in terms of changed or delayed treatment are described for patients who had surgery in 2020, compared with those who had surgery in 2018–2019. The study found that mainly non-cancer surgical treatments were cancelled during months with high COVID-19 rates. Outcomes for patients undergoing surgery were similar but with fewer ICU admissions and shorter hospital stay. These data provide no insight into the burden endured by patients who had postponed or cancelled operations.

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Figures

**Fig. 1**
Numbers of patients who had surgery every week during 2020 compared with mean number of procedures performed in historical reference cohort of 2018–2019

See this image and copyright information in PMC

References

1. WHO . WHO Coronavirus (COVID-19) Dashboard. [cited 2022 Apr 22]. https://covid19.who.int/.
1. WHO . The Impact of COVID-19 on Health and Care Workers: a Closer Look at Deaths. Health Workforce Department—Working Paper 1 (WHO/HWF/WorkingPaper/2021.1). Geneva: WHO, 2021
1. Di Marzo F, Sartelli M, Cennamo R, Toccafondi G, Coccolini F, La Torre G et al. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2). Br J Surg 2020;107:1104–1106 - PMC - PubMed
1. OECD/European Observatory on Health Systems and Policies . State of Health in the EU —The Netherlands: Country Health Profile 2021. Paris: OECD Publishing, 2021
1. COVIDSurg Collaborative . Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020;107:1440–1449 - PMC - PubMed

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Impact of the COVID-19 pandemic on surgical care in the Netherlands

Collaborators

Affiliations

Impact of the COVID-19 pandemic on surgical care in the Netherlands

Authors

Collaborators

Affiliations

Abstract

Plain language summary

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical