PDF(Pubmed)
Abstract：
BACKGROUND: As part of the Covid-19-restrictions in Switzerland, a federal ban on non-urgent examinations and treatments was applied to all hospitals during six weeks in spring 2020 (\"spring lockdown\"). The aim of this study was to comprehensively investigate the consequences of the Covid-19 pandemic on Swiss inpatient admissions based on data of all hospitals, focusing on selected procedures of different medical urgency.
METHODS: The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year).
RESULTS: During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019.
CONCLUSIONS: The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.
METHODS: The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year).
RESULTS: During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019.
CONCLUSIONS: The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.
摘要：
背景：作为瑞士Covid-19限制的一部分，联邦禁止非紧急检查和治疗在2020年春季的六周内适用于所有医院（“春季封锁”）。这项研究的目的是根据所有医院的数据，全面调查新冠肺炎大流行对瑞士住院的影响，专注于不同医疗紧迫性的选定程序。
方法：该研究包括所有急性护理住院病例（包括Covid-19病例，根据瑞士医院医疗统计，不包括精神病学和康复病例)。除了总录取人数,按地区细分，医院类型和年龄组，我们专注于代表不同医疗紧迫性的选定程序：选择性手术，癌症手术，和紧急情况。程序是根据专家访谈选择的。我们比较了春季禁闭期间以及2020年和2021年全年的入学人数，其绝对数量和百分比变化与2019年相应时期（基准年）的变化。
结果：在弹簧锁定期间，到2020年底，入院人数减少47,156人（32.2%），没有追赶效应（-72,817人/-5.8%）。特定程序的减少高达86％，选择性手术的住院率下降幅度最大，只有在少数程序的情况下才能完全逆转的下降，如关节成形术。引人注目的是，在春季封锁期间，由于紧急情况而导致的入院人数也大大减少（中风-14％；急性心肌梗死STEMI：-9％，NSTEMI：-26%）。癌症手术中选定程序的结果未显示出一致的模式。2021年，大多数手术的录取人数达到甚至超过2019年。
结论：入学人数大幅减少，特别是在选修程序中，可能反映了分诊对春季封锁期间预期的新冠肺炎病例的影响。到2020年底，相对于以前，入学人数仍处于较低水平，大流行前的一年。2021年的数字达到了2019年的水平，这表明新冠肺炎疫情只是暂时影响了瑞士的住院医疗保健。观察到的紧急情况和癌症手术入院人数减少的长期后果需要在个人层面进行调查。
方法：该研究包括所有急性护理住院病例（包括Covid-19病例，根据瑞士医院医疗统计，不包括精神病学和康复病例)。除了总录取人数,按地区细分，医院类型和年龄组，我们专注于代表不同医疗紧迫性的选定程序：选择性手术，癌症手术，和紧急情况。程序是根据专家访谈选择的。我们比较了春季禁闭期间以及2020年和2021年全年的入学人数，其绝对数量和百分比变化与2019年相应时期（基准年）的变化。
结果：在弹簧锁定期间，到2020年底，入院人数减少47,156人（32.2%），没有追赶效应（-72,817人/-5.8%）。特定程序的减少高达86％，选择性手术的住院率下降幅度最大，只有在少数程序的情况下才能完全逆转的下降，如关节成形术。引人注目的是，在春季封锁期间，由于紧急情况而导致的入院人数也大大减少（中风-14％；急性心肌梗死STEMI：-9％，NSTEMI：-26%）。癌症手术中选定程序的结果未显示出一致的模式。2021年，大多数手术的录取人数达到甚至超过2019年。
结论：入学人数大幅减少，特别是在选修程序中，可能反映了分诊对春季封锁期间预期的新冠肺炎病例的影响。到2020年底，相对于以前，入学人数仍处于较低水平，大流行前的一年。2021年的数字达到了2019年的水平，这表明新冠肺炎疫情只是暂时影响了瑞士的住院医疗保健。观察到的紧急情况和癌症手术入院人数减少的长期后果需要在个人层面进行调查。
