Impact of SARS-CoV-2 on elective surgical volume in Tuscany: effects on local planning and resource prioritization

Marzo, Francesco Di; Gemmi, Fabrizio; Cennamo, Rosario; Forni, Silvia; Bachini, Letizia; Collini, Francesca; Cardi, Maurizio

doi:10.1002/bjs.11832

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Hospitalizations for femoral neck fracture in the elderly decreased, probably due to the limited mobility imposed by the confinement measures, while hip and knee replacements were heavily affected by the interruption of non-urgent surgery and the need to adapt surgical and outpatient activities to the new safety regulations 3 . This suspension has likely left room for an improvement in the timeliness management of emergencies, as in the case of the femoral neck fracture.…”

Section: Discussionmentioning

confidence: 99%

“…In response to the first epidemic outbreak in Lombardy, which rapidly spread to other regions, the government issued the first national lockdown starting on 9 March 2020. Since then, evidence had accrued on its possible effects on people’s health 2 , 3 . Services whose benefits could be lower than the patient’s risk of infection and the organizational difficulties were postponed, and the population was recommended to avoid unnecessary access to health services.…”

Section: Introductionmentioning

confidence: 99%

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Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

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Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January–July 2020 were compared with the corresponding average for 2018–2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30–40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

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“…However, it would not be appropriate to make a fair comparison of their analysis to the current study results since both were relatively small centres of less than a hundred beds, had low COVID-19 infection rates and maintained reliable capacities for ventilation of ill patients and intensive care unit (ICU) beds throughout the epidemic (Deiner et al, 2014 ). In Italy, at the peak of the epidemic curve when 91.3% of the ICU beds were used for COVID-19 patients, elective surgery reduced by 75.0% while urgent or emergency surgery then decreased by 30.0% (Di Marzo et al, 2020 ). The study reported short-term impact of surgeries performed, looking into significantly higher median operative time, stay in OT and rate of patients with Clavien-Dindo grade 3b postoperative complications requiring a second procedure within 7 days but not the effect on rescheduled cases after that cancellation period (Dindo et al, 2004 ).…”

Section: Discussionmentioning

confidence: 99%

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

et al. 2022

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Background Many institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery. Methods This was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear. Results A total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035). Conclusion The mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.

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Section: Discussionmentioning

confidence: 99%

“…The Covid-19 pandemic in Italy has caused more than 4,2 million cases of infection and over 130,000 deaths to date [1]. Following the first epidemic outbreak in Lombardy, which rapidly spread to other regions, the government issued the first national lockdown starting on 9 March 2020, and since then, evidence had accrued on its possible effects on people's health [2][3]. Services whose benefits could be lower than both the patient's risk of infection and the organizational difficulties were postponed, and citizens were recommended to avoid unnecessary access to health services.…”

Section: Introductionmentioning

confidence: 99%

Monitoring the indirect impact of Covid-19 on hospital care pathways in Italy: results from the Mimico-19 network

Spadea

Girolamo

Landriscina

et al. 2021

Preprint

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The COVID-19 pandemic has a non-negligible indirect impact on hospital care pathways, which is important to estimate. To this aim, we set up the Mimico-19 network of seven Italian regions (62% of the Italian population) representing different socio-demographic areas of the country with also a different burden of the epidemic. We retrospectively analysed regional hospital discharges data, computing twelve indicators of volumes and performance in three clinical areas: cardiology, oncology and orthopaedics, including time-dependent pathways and elective surgery. Weekly indicators for the period January-July 2020 were compared with the average of the corresponding indicators in 2018 and 2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown and post-lockdown. The weekly trend of hospitalizations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Volumes of malignant neoplasms surgeries differed substantially by site, with a limited reduction for lung cancer (<20%) and greater declines (30-40%) for breast and prostate cancers. Hospitalizations for femoral neck fracture in the elderly decreased by 20%, but the percentage of timely interventions remained constantly higher than the previous years. General trends did not show important differences across regions, regardless of the different Covid-19 burden. Hospitalizations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. The drop in the care demand for cardiovascular diseases and cancers needs to be further investigated and monitored more thoroughly.

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Impact of SARS-CoV-2 on elective surgical volume in Tuscany: effects on local planning and resource prioritization

Cited by 8 publications

References 5 publications

Indirect impact of Covid-19 on hospital care pathways in Italy

Indirect impact of Covid-19 on hospital care pathways in Italy

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

Monitoring the indirect impact of Covid-19 on hospital care pathways in Italy: results from the Mimico-19 network

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