Pestana Daniel, Joshi Divya, Duan Erick, Fowler Robert, Tsang Jennifer, Binnie Alexandra
William Osler Health System, Brampton, ON, Canada.
Algarve Biomedical Centre Research Institute, University of Algarve, Faro, Portugal.
Can J Anaesth. 2025 Mar;72(3):481-491. doi: 10.1007/s12630-024-02894-z. Epub 2024 Dec 17.
During the COVID-19 pandemic, neighbourhoods with high material deprivation and high proportions of racialized Canadians were disproportionately affected by COVID-19. Many of these neighbourhoods were served by community hospitals. We sought to compare the burden of COVID-19 care in community and academic intensive care units (ICUs) in Ontario, Canada.
We included all adult patients admitted to Ontario ICUs with COVID-19 between 1 March 2020 and 31 July 2021 in a retrospective cohort study. We compared patient volumes, demographics, interventions, and outcomes between community hospital corporations (CHCs) and academic hospital corporations (AHCs).
During the first three waves of the pandemic, 9,651 adult ICU admissions for COVID-19 were reported across 72 hospital corporations in Ontario: 6,902 (71.5%) in CHCs and 2,749 (28.5%) in AHCs. Days of ICU care per baseline ICU bed were highest in large CHCs (> 10 baseline ICU beds) relative to AHCs and small CHCs (median [interquartile range], 73.7 [53.8-110.6] vs 42.2 [32.7-71.8] vs 21.4 [7.2-40.3]; Kruskal-Wallis test, P < 0.001). Among direct ICU admissions, CHC patients had greater severity of illness whereas among transfer ICU admissions, AHC patients were more severely ill. In a multivariable logistic regression model, mortality was similar among patients with index admission to a CHC or AHC; however, patients with index admission to an AHC were more likely to receive extracorporeal membrane oxygenation (adjusted odds ratio, 6.16; 95% confidence interval, 4.72 to 8.11).
During the pandemic, Ontario's large CHCs provided significantly more days of ICU COVID-19 care per baseline ICU bed compared with AHCs and small CHCs. Equipping large CHCs to handle ICU surges during future emerging disease outbreaks should be a priority for pandemic preparedness.
在新冠疫情期间，物质匮乏程度高且加拿大种族化人口比例高的社区受新冠疫情影响尤为严重。这些社区中有许多由社区医院提供服务。我们试图比较加拿大安大略省社区和学术重症监护病房（ICU）中新冠护理的负担。
我们纳入了2020年3月1日至2021年7月31日期间因新冠入住安大略省ICU的所有成年患者，进行一项回顾性队列研究。我们比较了社区医院集团（CHC）和学术医院集团（AHC）之间的患者数量、人口统计学特征、干预措施和结局。
在疫情的前三波期间，安大略省72家医院集团共报告了9651例因新冠入住成人ICU的病例：社区医院集团有6902例（71.5%），学术医院集团有2749例（28.5%）。相对于学术医院集团和小型社区医院集团，大型社区医院集团（基线ICU床位>10张）每张基线ICU床位的ICU护理天数最高（中位数[四分位间距]，73.7[53.8 - 110.6]天 vs 42.2[32.7 - 71.8]天 vs 21.4[7.2 - 40.3]天；Kruskal - Wallis检验，P<0.001）。在直接入住ICU的患者中，社区医院集团的患者病情更严重，而在转入ICU的患者中，学术医院集团的患者病情更严重。在多变量逻辑回归模型中，初次入住社区医院集团或学术医院集团的患者死亡率相似；然而，初次入住学术医院集团的患者更有可能接受体外膜肺氧合治疗（调整后的优势比，6.16；95%置信区间，4.72至8.11）。
在疫情期间，安大略省的大型社区医院集团每张基线ICU床位提供的新冠ICU护理天数显著多于学术医院集团和小型社区医院集团。使大型社区医院集团有能力在未来新发疾病暴发期间应对ICU需求激增，应成为大流行防范的优先事项。
