PDF(Pubmed)
Abstract：
Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery, leading to the cancellation and postponement of various health services, including surgery. Numerous countries closed their borders and established laws mandating the use of face masks and social distancing and enforced lockdowns, and various activities were constrained. Brazil, the largest and most populous country in Latin America, also experienced a rapid and sustained surge in infections and deaths. Brazil was the most severely impacted nation in Latin America. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aimed to assess the impact of the COVID-19 pandemic on surgical services throughout the entire period. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022 and compared the following indicators: (1) number of hospital admissions, (2) length of hospital stay (LOS) (in days), and (3) volume of urgent and elective procedures. Data was divided into four time periods, pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the number of admissions and LOS based on surgical procedures performed by stratifying according to region, sex, age, and type of surgery (urgent versus elective). Results The number of admissions for surgical procedures ranged between 859,646 and 4,015,624 for 2019, 686,616 and 3,419,234 for 2020, 787,791 and 3,829,019 for 2021, and 760,512 and 3,857,817 for 2022 for the category of region; 4,260,900 and 5,991,775 for 2019, 3,594,117 and 4,984,710 for 2020, 4,182,640 and 5,590,808 for 2021, and 4,077,651 and 5,561,928 for 2022 for the category of sex; and 2,170,288 and 3,186,117 for 2019, 1,516,830 and 2,825,189 for 2020, 1,748,202 and 3,030,272 for 2021, and 1,900,023 and 2,859,179 for 2022 for the category of age. The variable age showed a comparable trend, albeit with an expressive decline for surgeries in the age range of 0-19 years. The LOS (in days) for surgical procedures ranged between 110,157 and 910,846 for 2019, 58,562 and 897,734 for 2020, 67,926 and 904,137 for 2021, and 100,467 and 823,545 for 2022. Thoracic surgery indicated no statistically significant difference in the number of admissions and LOS. Elective surgeries had a decline in the number of admissions and LOS, a 13% and 9.3% decline between 2019 and 2020, respectively. Urgent surgeries experienced a slight decrease in admissions and LOS, with a decline of 2.4% and 2.8% between 2019 and 2020, respectively. Conclusions Population characteristics, such as age, sex, and region, showed decreased hospital admissions during the pandemic, followed by a recovery toward pre-pandemic levels afterward. The number of surgical admissions and the length of hospital stays decreased during the pandemic but gradually returned to pre-pandemic levels in the recovery and post-pandemic phases. Notably, thoracic surgery remained statistically consistent across all periods, indicating its emergency nature compared to other surgeries. Thus, we conclude that the pandemic had minimal impact on thoracic surgery cases, contributing to a stable trend.
摘要：
背景2019年冠状病毒病(COVID-19)大流行引发了医疗保健服务的中断，导致各种卫生服务的取消和推迟，包括手术。许多国家关闭了边境，并制定了法律，强制使用口罩和社交距离，并强制实行封锁。各种活动受到限制。巴西,拉丁美洲人口最多的国家,感染和死亡人数也迅速持续激增。巴西是拉丁美洲受影响最严重的国家。大流行对巴西外科服务的影响尚未得到充分研究，因为大多数研究仅涵盖大流行的早期阶段。因此，本研究旨在评估COVID-19大流行对整个期间手术服务的影响.方法采用回顾性横断面设计对2019年至2022年的手术病例进行检查,比较以下指标:(1)住院人数、（2）住院时间（LOS）（天），和(3)紧急和选择性程序的数量。数据分为四个时间段，大流行前（2019年3月至12月），大流行（2020年3月至12月），恢复（2021年3月至12月），和大流行后（2022年3月至12月），并根据按地区分层进行的外科手术分析入院人数和LOS，性别,年龄,和手术类型（紧急与选择性）。结果2019年外科手术的入院人数在859,646和4,015,624之间，2020年为686,616和3,419,234之间，2021年为787,791和3,829,019之间，2022年为760,512和3,857,817地区类别；2019年为4,260,900和5,991,594,117，2020年为3,894,可变年龄表现出可比的趋势，尽管在0-19岁的年龄范围内手术的表达下降。外科手术的LOS（天）在2019年为110,157和910,846，在2020年为58,562和897,734，在2021年为67,926和904,137，在2022年为100,467和823,545。胸外科手术显示入院人数和LOS无统计学差异。选择性手术的入院人数和LOS人数有所下降，2019年至2020年期间分别下降13%和9.3%。紧急手术的入院率和LOS略有下降，2019年至2020年期间分别下降2.4%和2.8%。结论人口特征，比如年龄,性别,和区域,在大流行期间显示住院人数减少，随后恢复到大流行前的水平。在大流行期间，手术入院人数和住院时间有所减少，但在恢复和大流行后阶段逐渐恢复到大流行前的水平。值得注意的是,胸外科手术在所有时期都保持统计一致，表明其与其他手术相比的紧急性质。因此，我们得出的结论是，大流行对胸外科病例的影响很小，有助于稳定的趋势。
