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Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic
PURPOSE: The mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality po...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9959950/ https://www.ncbi.nlm.nih.gov/pubmed/36840798 http://dx.doi.org/10.1007/s00134-023-07000-3 |
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author | Duclos, Antoine Cordier, Quentin Polazzi, Stéphanie Colin, Cyrille Rimmelé, Thomas Lifante, Jean-Christophe Carty, Matthew J. Boyer, Laurent |
author_facet | Duclos, Antoine Cordier, Quentin Polazzi, Stéphanie Colin, Cyrille Rimmelé, Thomas Lifante, Jean-Christophe Carty, Matthew J. Boyer, Laurent |
author_sort | Duclos, Antoine |
collection | PubMed |
description | PURPOSE: The mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality potentially attributable to ICU/IMCUs overwhelmed by COVID-19, and any hospital learning effects between two successive pandemic waves. METHODS: This nationwide observational study included all patients without COVID-19 who underwent surgery in France from 01/01/2019 to 31/12/2020. We determined pandemic exposure of each operated patient based on the daily proportion of COVID-19 patients among all patients treated within the ICU/IMCU beds of the same hospital during his/her stay. Multilevel models, with an embedded triple-difference analysis, estimated standardized in-hospital mortality and compared mortality between years, pandemic exposure groups, and semesters, distinguishing deaths inside or outside the ICU/IMCUs. RESULTS: Of 1,870,515 non-COVID-19 patients admitted for surgery in 655 hospitals, 2% died. Compared to 2019, standardized mortality increased by 1% (95% CI 0.6–1.4%) and 0.4% (0–1%) during the first and second semesters of 2020, among patients operated in hospitals highly exposed to pandemic. Compared to the low-or-no exposure group, this corresponded to a higher risk of death during the first semester (adjusted ratio of odds-ratios 1.56, 95% CI 1.34–1.81) both inside (1.27, 1.02–1.58) and outside the ICU/IMCU (1.98, 1.57–2.5), with a significant learning effect during the second semester compared to the first (0.76, 0.58–0.99). CONCLUSION: Significant excess mortality essentially occurred outside of the ICU/IMCU, suggesting that access of surgical patients to critical care was limited. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-023-07000-3. |
format | Online Article Text |
id | pubmed-9959950 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-99599502023-02-28 Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic Duclos, Antoine Cordier, Quentin Polazzi, Stéphanie Colin, Cyrille Rimmelé, Thomas Lifante, Jean-Christophe Carty, Matthew J. Boyer, Laurent Intensive Care Med Original PURPOSE: The mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality potentially attributable to ICU/IMCUs overwhelmed by COVID-19, and any hospital learning effects between two successive pandemic waves. METHODS: This nationwide observational study included all patients without COVID-19 who underwent surgery in France from 01/01/2019 to 31/12/2020. We determined pandemic exposure of each operated patient based on the daily proportion of COVID-19 patients among all patients treated within the ICU/IMCU beds of the same hospital during his/her stay. Multilevel models, with an embedded triple-difference analysis, estimated standardized in-hospital mortality and compared mortality between years, pandemic exposure groups, and semesters, distinguishing deaths inside or outside the ICU/IMCUs. RESULTS: Of 1,870,515 non-COVID-19 patients admitted for surgery in 655 hospitals, 2% died. Compared to 2019, standardized mortality increased by 1% (95% CI 0.6–1.4%) and 0.4% (0–1%) during the first and second semesters of 2020, among patients operated in hospitals highly exposed to pandemic. Compared to the low-or-no exposure group, this corresponded to a higher risk of death during the first semester (adjusted ratio of odds-ratios 1.56, 95% CI 1.34–1.81) both inside (1.27, 1.02–1.58) and outside the ICU/IMCU (1.98, 1.57–2.5), with a significant learning effect during the second semester compared to the first (0.76, 0.58–0.99). CONCLUSION: Significant excess mortality essentially occurred outside of the ICU/IMCU, suggesting that access of surgical patients to critical care was limited. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-023-07000-3. Springer Berlin Heidelberg 2023-02-25 2023 /pmc/articles/PMC9959950/ /pubmed/36840798 http://dx.doi.org/10.1007/s00134-023-07000-3 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Duclos, Antoine Cordier, Quentin Polazzi, Stéphanie Colin, Cyrille Rimmelé, Thomas Lifante, Jean-Christophe Carty, Matthew J. Boyer, Laurent Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title | Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title_full | Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title_fullStr | Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title_full_unstemmed | Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title_short | Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic |
title_sort | excess mortality among non-covid-19 surgical patients attributable to the exposure of french intensive and intermediate care units to the pandemic |
topic | Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9959950/ https://www.ncbi.nlm.nih.gov/pubmed/36840798 http://dx.doi.org/10.1007/s00134-023-07000-3 |
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