Impact of the COVID-19 pandemic on surgical care in the Netherlands

Abstract

Background The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. Methods A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. Results Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). Conclusion The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward

“…For example, in a study from the Netherlands, a reduction was noted in the number of surgeries performed that was greatest for patients without cancer. However, when surgery was performed, it appeared to be performed safely, with similar rates of complications and mortality, a shorter hospital stay, and fewer admissions to the ICU [ 44 ]. Interestingly, even though one would anticipate that due to fewer surgical interventions during the pandemic, leading to a lower number of infectious complications and, thus, to a lower number of microorganisms isolated as well, this was not observed during this study.…”

Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study*

“…Furthermore, fewer social contacts and more social distancing most likely reduced the spread of other infectious diseases as well. In addition, delays in elective surgery to create ICU capacity ( 3 ) might have resulted in more severely ill elective patients once they arrived at the ICU. This mechanism could explain the lower volumes and higher in-hospital mortality found in elective surgery and CABG patients admitted during the pandemic period.…”

“…However, this efficiency can strain capacity during emergencies like epidemics, as seen during the COVID-19 pandemic when Dutch ICU capacity increased from 1100 to 1700 beds in April 2020 ( 2 ). Hospitals adopted a crisis strategy that involved, amongst others, the reallocation of personnel and repurposing of surgical theaters and postoperative recovery areas into ICUs ( 3 ). The ICUs were forced to alter regular nursing and staff ratios and to bypass the Dutch Guidelines for Intensive Care stating that an ICU nurse in the Netherlands takes care for one or two patients per shift ( 4 ).…”

“…During the pandemic, the main focus was on accommodating COVID-19 patients, potentially impacting non-COVID-19 care. These impacts include: reduced elective surgeries ( 3 , 6 , 7 ), lower emergency department utilization ( 8 – 10 ), and decreased medical consultations ( 11 ). However, uncertainties regarding types of admission, diseases, and severity strata during the pandemic period and its peaks for all ICU patients within the Dutch healthcare system remain.…”

The impact of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer

“…Second, we also observed a relative reduction in palliative gastric resections performed in the second half of 2020 for patients diagnosed with incurable GC. Of note, surgical care during the COVID-19 pandemic was not associated with an increase in postoperative complications, neither pulmonary nor other [ 26 , 27 ].…”