The Impact of Elective Surgery Postponement during COVID-19 on Emergency Bellwether Procedures in Singapore
Introduction
•Elective surgery postponement was a common measure taken during the COVID-19 pandemic to conserve hospital resources and manpower1
•However, such measures might lead to collateral damage for patients’ health, function and quality of life2
Bellwether procedures3
•Caesarean section (CS), emergency laparotomy (EL) and open fracture (OF) fixation
•Used as indicators of the adequacy of systems, resources and skills needed to treat a broader range of essential surgical conditions
Aim
•To assess the impact of elective surgery postponement policy on surgical volumes and patient outcomes for the emergency bellwether procedures in SGH
Methods
Setting
•Singapore General Hospital
•Retrospective cohort study of patients who underwent CS, EL and OF fixation between 1 January 2018 to 31 December 2021
Data source
•SingHealth Electronic Health Intelligence System (eHIntS)
•Demographics, visit details, operation scheduling, peri-operative details, diagnosis and discharge disposition extracted
Exposure
•Pre-COVID (Jan 2018 – Jan 2020), Elective postponement (EP) (Feb – May 2020), Recovery (Jun – Nov 2020), Post-recovery (Dec 2020 – Dec 2021)
Outcomes
•Monthly surgical volume, length of stay (LOS), intensive care unit (ICU) admission, 30-day mortality
Statistical analysis
•Monthly surgical volume across 4 time periods
•Kruskal Wallis test
•Segmented negative binomial regression models (to evaluate change in volume of EP, recovery and post-recovery compared to the pre-COVID period)
•Clinical outcomes across 4 time periods
Kruskal Wallis test or chi-square test as appropriate
Results
Emergency Laparotomy (EL)
•Monthly volume of EL increased by 43% (95% CI: 23 – 67%) and 48% (95% CI: 21 – 80%) in the recovery and post-recovery period, respectively
Outcomes were better from the EP period onwards
Emergency Caesarean section (CS)
•No significant change in monthly volumes
•No significant differences in clinical outcomes except for a decrease in LOS during the post-recovery period
Emergency open fracture fixations (OF)
•No significant change in monthly volumes
•No significant differences in clinical outcomes
Conclusions
•Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume in EL after the postponement
•Outcomes were not worse throughout the entire period
•Valuable for healthcare systems to invest in data capture systems to track relevant outcomes in real time should such policies be implemented in future crises again to understand the impact and therefore adjust strategies in a timelier fashion
