Health Services Research Centre, SingHealth, 20 College Road, Academia, Level 6, Singapore 169856, Singapore.
Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
Int J Qual Health Care. 2024 Mar 21;36(1). doi: 10.1093/intqhc/mzae022.
The coronavirus disease 2019 (COVID-19) pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower, and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for three emergency bellwether procedures. A retrospective cohort study of patients who underwent any of the three emergency procedures [Caesarean section (CS), emergency laparotomy (EL), and open fracture (OF) fixation] between 1 January 2018 and 31 December 2021 was conducted using clinical and surgical data from electronic medical records. The volumes and outcomes of each surgery were compared across four time periods: pre-COVID (January 2018-January 2020), elective postponement (February-May 2020), recovery (June-November 2020), and postrecovery (December 2020-December 2021) using Kruskal-Wallis test and segmented negative binomial regression. There was a total of 3886, 1396, and 299 EL, CS, and OF, respectively. There was no change in weekly volumes of CS and OF fixations across the four time periods. However, the volume of EL increased by 47% [95% confidence interval: 26-71%, P = 9.13 × 10-7) and 52% (95% confidence interval: 25-85%, P = 3.80 × 10-5) in the recovery and postrecovery period, respectively. Outcomes did not worsen throughout the four time periods for all three procedures and some actually improved for EL from elective postponement onwards. Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume for EL after the postponement without any worsening of outcomes.
2019 年冠状病毒病（COVID-19）大流行促使全球许多医疗系统推迟择期手术，以增加医疗能力、人力，并降低工作人员感染风险。本研究旨在评估为应对 COVID-19 大流行而实施的择期手术推迟政策对三种紧急情况手术数量和患者结局的影响。本回顾性队列研究纳入了 2018 年 1 月 1 日至 2021 年 12 月 31 日期间接受三种紧急手术（剖宫产、急诊剖腹手术和开放性骨折固定术）的患者，使用电子病历中的临床和手术数据。使用 Kruskal-Wallis 检验和分段负二项回归比较了每个手术在四个时间段（COVID 前（2018 年 1 月至 2020 年 1 月）、择期推迟（2020 年 2 月至 5 月）、恢复期（2020 年 6 月至 11 月）和恢复期后（2020 年 12 月至 2021 年 12 月）的手术数量和结局。分别有 3886 例、1396 例和 299 例 EL、CS 和 OF。四个时间段内 CS 和 OF 固定术的每周手术量没有变化。然而，EL 的手术量在恢复期和恢复期后分别增加了 47%（95%置信区间：26-71%，P=9.13×10-7）和 52%（95%置信区间：25-85%，P=3.80×10-5）。所有三种手术在四个时间段内的结局均未恶化，EL 从择期推迟开始，一些结局实际上有所改善。COVID-19 大流行早期的择期手术推迟并未影响紧急 CS 和 OF 固定术的手术量，但导致推迟后 EL 的手术量增加，而结局无恶化。
