Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay

Abstract

Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. Methods We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. Results There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)—OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor—OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved—OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased. Conclusion A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.

Assessment of Healthcare Resource Utilization by Anticoagulant Heparinoid Dosage Level in Patients Hospitalized with COVID-19

“…Total hospitalization costs in this study were similar to others 35 but were significantly higher among recipients of high-versus low-dose anticoagulation. Similarly, overall ICU utilization was in line with that reported in other studies of patients with COVID-19, 32,33,39 but was twice as high among patients who received highversus low-dose anticoagulation, and consistent with another retrospective study reporting a three-fold increase in ICU admission. 30 Variations in HRU and costs across studies probably reflect differences in study time periods, geographic locations, and severity of illness indicators.…”

“…In this study, overall findings on hospital LOS, ICU utilization, and cost were in line with results from studies of patients with COVID-19 in which assessment was not based on anticoagulant dose. [32][33][34][35][37][38][39][40] Among all inpatients, median LOS was approximately two days shorter than that reported by others, 32,34,39,50 but after examining anticoagulant use, we found that LOS was about 3 days longer among patients receiving high-versus low-dose heparinoids. Total hospitalization costs in this study were similar to others 35 but were significantly higher among recipients of high-versus low-dose anticoagulation.…”

“…32 – 37 In studies of hospitalized patients, ICU utilization ranged from 15% to 52%. 33 , 35 , 37 – 39 Among inpatients with COVID-19, increased total cost and length of stay (LOS) are associated with greater comorbidity burden, poorer hematologic biomarkers, worse clinical severity, and certain demographic characteristics. 32 , 35 , 37 , 39 , 40 Before the COVID-19 pandemic, studies in hospital and outpatient settings evaluated the cost-effectiveness and clinical efficacy of various thromboprophylaxis strategies.…”

“…31 COVID-19 is associated with substantial healthcare resource utilization (HRU) and costs. [32][33][34][35][36][37] In studies of hospitalized patients, ICU utilization ranged from 15% to 52%. 33,35,[37][38][39] Among inpatients with COVID-19, increased total cost and length of stay (LOS) are associated with greater comorbidity burden, poorer hematologic biomarkers, worse clinical severity, and certain demographic characteristics.…”

Standardized Preoperative Pathways Determining Preoperative Echocardiogram Usage Continue to Improve Hip Fracture Quality

“…It is important to note the backdrop of the COVID-19 pandemic in spring 2020 (many of the post-protocol cohort patients) placed a large burden on the healthcare system, resulting in worse outcomes and hospital quality measures, notably, increased mortality rates and longer hospitalizations. 29 , 30 The cause of this shortened length of stay is likely 3-fold. First, the protocol reduced the time to surgery which has been previously demonstrated to reduce overall length of stay and allow for more rapid rehabilitation and improvement in functional outcomes.…”