背景:先前的一项研究报告,由于法国COVID-19病例的资源优先排序导致手术护理中断,非COVID-19患者的死亡率明显过高。主要目的是调查是否对医疗状况产生类似的影响,并确定在法国大流行的第一年,医院饱和度对非COVID-19医院死亡率的影响。
方法:我们在2020年3月1日至5月31日期间在法国进行了一项基于人群的全国性队列研究,纳入了所有因非COVID-19急性疾病住院的成年患者。2020年(第1波)和2020年9月1日和2020年12月31日(第2波)。根据COVID-19每周的床位占用情况,医院饱和度分为四个级别:无饱和度(<5%),低饱和度(>5%和≤15%),中等饱和度(>15%和≤30%),和高饱和度(>30%)。多元广义线性模型分析了医院饱和度与死亡率之间的关系,并调整了年龄,性别,COVID-19波,Charlson合并症指数,案例混合,入院来源,入住ICU,医院类别和居住地。
结果:共有2,264,871名成年患者因急性疾病住院。在多变量分析中,低饱和医院的医院死亡率明显更高(调整后的赔率/aOR=1.05,95%CI[1.34-1.07],P<.001),中度饱和医院(aOR=1.12,95%CI[1.09-1.14],P<.001),和高度饱和的医院(aOR=1.25,95%CI[1.21-1.30],P<.001)与非饱和医院相比。在高度饱和的医院中,ICU以外的死亡比例较高(87%),低或中等饱和医院(81-84%)。医院饱和对死亡率的负面影响在65岁以上的患者中更为明显,合并症较少的人(Charlson1-2和3vs.0),癌症患者,神经和精神疾病,那些从家里或通过急诊室入院的人(与从其他医院病房转院的人相比),和那些没有进入重症监护室的人。
结论:我们的研究揭示了值得注意的“剂量效应”关系:随着医院饱和度的增加,非COVID-19医院死亡风险也增加。这些结果引起了人们对医院韧性和患者安全的担忧,强调确定有针对性的战略以增强未来弹性的重要性,特别是高危患者。
BACKGROUND: A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. The primary objective was to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital mortality during the first year of the pandemic in France.
METHODS: We conducted a nationwide population-based cohort study including all adult patients hospitalized for non-COVID-19 acute medical conditions in France between March 1, 2020 and 31 May, 2020 (1st wave) and September 1, 2020 and December 31, 2020 (2nd wave). Hospital saturation was categorized into four levels based on weekly bed occupancy for COVID-19: no saturation (< 5%), low saturation (> 5% and ≤ 15%), moderate saturation (> 15% and ≤ 30%), and high saturation (> 30%). Multivariate generalized linear model analyzed the association between hospital saturation and mortality with adjustment for age, sex, COVID-19 wave, Charlson Comorbidity Index, case-mix, source of hospital admission, ICU admission, category of hospital and region of residence.
RESULTS: A total of 2,264,871 adult patients were hospitalized for acute medical conditions. In the multivariate analysis, the hospital mortality was significantly higher in low saturated hospitals (adjusted Odds Ratio/aOR = 1.05, 95% CI [1.34-1.07], P < .001), moderate saturated hospitals (aOR = 1.12, 95% CI [1.09-1.14], P < .001), and highly saturated hospitals (aOR = 1.25, 95% CI [1.21-1.30], P < .001) compared to non-saturated hospitals. The proportion of deaths outside ICU was higher in highly saturated hospitals (87%) compared to non-, low- or moderate saturated hospitals (81-84%). The negative impact of hospital saturation on mortality was more pronounced in patients older than 65 years, those with fewer comorbidities (Charlson 1-2 and 3 vs. 0), patients with cancer, nervous and mental diseases, those admitted from home or through the emergency room (compared to transfers from other hospital wards), and those not admitted to the intensive care unit.
CONCLUSIONS: Our study reveals a noteworthy \"dose-effect\" relationship: as hospital saturation intensifies, the non-COVID-19 hospital mortality risk also increases. These results raise concerns regarding hospitals\' resilience and patient safety, underscoring the importance of identifying targeted strategies to enhance resilience for the future, particularly for high-risk patients.