与 COVID-19 大流行相关的眼科手术积压：基于人群和微观模拟建模研究。
The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study.
机构信息
Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont.
出版信息
CMAJ Open. 2021 Nov 23;9(4):E1063-E1072. doi: 10.9778/cmajo.20210145. Print 2021 Oct-Dec.
BACKGROUND
Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario.
METHODS
This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years.
RESULTS
A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries).
INTERPRETATION
The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.
背景
为减轻 COVID-19 的影响，全球各地纷纷减少眼科手术，由此产生了全球手术积压。我们旨在预测 COVID-19 对安大略省非紧急眼科亚专科手术及时提供的长期影响。
方法
这是一项微观模拟模型研究。我们使用了安大略省基于人群的行政数据，这些数据来自等候时间信息系统数据库 2019 年 1 月至 2021 年 5 月和设施层面的数据 2018 年 3 月至 2021 年 5 月，以估计与 COVID-19 大流行相关的积压量和等候时间。对于大流行后恢复期，我们估计了清除大流行期间在等候名单上积累的患者积压所需的资源。结果在 3 年的时间范围内累积。
结果
截至 2020 年 3 月 15 日，安大略省共有 56923 名患者在等候名单上，等待非紧急眼科手术。2020 年 5 月和 2021 年 5 月，该省非紧急手术数量与 2019 年同期相比分别下降了 97%和 80%。自大流行开始以来的 2 年和 3 年，预计等候手术的患者总数分别增加了 129%和 150%。所有亚专科手术的患者估计平均等候时间在 2023 年 3 月增加到 282（标准差[SD]91）天，而 2019 年为 94（SD97）天。到 2023 年 3 月，清除积压所需的省级每月额外资源估计比大流行前的数量增加 34%（额外进行 4626 次手术）。
解释
这项微观模拟模型研究的估计表明，COVID-19 大流行导致的眼科手术积压规模对恢复期具有重要影响。该模型可适用于其他司法管辖区，以协助规划挽救视力的手术恢复。
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