Acute general surgery hospital admissions during the first two weeks of the spring 2020 lockdown in England dropped sharply as medics freed up capacity for COVID-19 patients and tried to avoid exposing patients to the virus. According to a study published in Surgery Research and Practice, the number of patients seen by the general surgical team in Bedford Hospital roughly halved compared to the previous year. However, this natural experiment had an encouraging outcome: although 59% of those assessed were admitted to the hospital in 2020 compared to 77% in 2019, no ill effects were found within a month among those who were not admitted.
The COVID-19 pandemic put huge pressure on the UK's National Health Service. Strategies to free up intensive care capacity included cancelling non-urgent surgeries, conservative management of acute conditions where possible, and increasing the threshold for patient admission.
In order to investigate the effects of these strategies on patient outcomes, and the potential impact of raising the threshold for patient admission in future, a team of researchers examined patients who were processed by an emergency surgical team in a UK district hospital over a 2-week period in spring 2020, near the height of the first wave of the pandemic. The researchers compared these patients with those processed within the same 2-week window in 2019.
2020 saw approximately half the number of hospital visits compared to 2019 (61 vs 126), reflecting a general public reluctance to go to the hospital. Of those who did attend in 2020, almost 25% fewer were admitted because of efforts to suppress COVID-19.
Of the 25 patients discharged without admission in 2020, 22 did not return to the hospital within 30 days, and of the 3 readmitted, only 1 required surgery. There were 4 mortalities in the 2020 cohort, one of whom received a COVID-19 diagnosis 12 days after initial admission, indicating they might have caught the virus while admitted. Four positive COVID-19 swabs further demonstrate the risk of SARS-CoV-2 infection to patients admitted to hospitals.
The combination of patients being less likely to visit a hospital in the first place, and a decrease in the proportion of patients then admitted led to a substantial reduction in hospital admissions with no adverse outcomes according to 30-day readmission data. However, it is important to note that there was a significant increase in length of stay for those patients who were admitted to the hospital. Although this could be expected from the increased admission threshold, the authors warn that it is also possible that patients may have delayed presenting at the hospital until their condition had progressed to a more serious stage, emphasizing the importance of public confidence in the safety of attending hospitals.
Post-pandemic, the researchers suggest that if this conservative approach is confirmed to be safe, then more surgical patients whose condition is not serious might be treated as outpatients, saving them a hospital stay and reducing healthcare costs.
This blog post is distributed under the Creative Commons Attribution License (CC-BY). Illustration by David Jury.