Impact of the COVID-۱۹ Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland – A Retrospective Study Based on Insurance Claims Data

Background  The severe acute respiratory syndrome coronavirus ۲ (SARS‑CoV‑۲) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease ۲۰۱۹ (COVID‑۱۹), yet the impact on elective and emergency inpatient procedure volumes is unclear.Methods  We analyzed anonymized data on ۲۳۴ ۹۲۱ hospitalizations in ۲۰۱۷‑۲۰۲۰ (۵۵.۹% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre‑pandemic data, the expected weekly numbers of procedures in ۲۰۲۰ in the absence of a pandemic and compared these to the observed numbers in ۲۰۲۰. Compensation effects were investigated by discretely integrating the difference between the two numbers over time.Results  During the first COVID‑۱۹ wave in spring ۲۰۲۰, elective procedure numbers decreased by ۵۲.۹% (۹۵% confidence interval ‑۶۴.۵% to ‑۴۲.۵%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by ۴۵.۵% and ۷۲.۴%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of ‑۹.۹% (‑۱۵.۸% to ‑۴.۵%) for the whole year ۲۰۲۰. Emergency procedure numbers also decreased by ۱۷.۱% (‑۲۳.۷% to ‑۹.۸%) during the first wave, but over the whole year ۲۰۲۰, net emergency procedure volumes were similar to control years.Conclusion  Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non‑COVID‑۱۹ related care is maintained during future pandemic phases in order to prevent negative health consequences.

Keywords:

COVID‑۱۹ , Inpatient , Hospitals , Surgery , Undertreatment , Switzerland