Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic

Fluck, David; Rankin, Suzanne; Lewis, Andrea F.; Robin, Jonathan; Rees, Jacqui; Finch, Jo; Jones, Yvonne; Jones, Gareth; Kelly, Kevin; Murray, P.; Wood, Michael; Fry, Christopher; Han, Thang S.

doi:10.1007/s11739-021-02842-5

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…By contrast, COVID-19 admissions in wave-2 were more gradual, but the total number of admissions were much higher. We have demonstrated that non-COVID admissions mirrored closely the peaks and troughs of COVID-19 admissions [5].…”

Section: Patient Characteristicsmentioning

confidence: 64%

“…These findings were confirmed by multivariable logistic regression with adjustments for age, sex and CCI, showing no evidence for an increase in readmission or mortality amongst patients admitted during the pandemic compared to those admitted before the pandemic (reference group), within early, intermediate or late discharge group. These findings were corroborated by evidence that the numbers of patients admitted with general medical conditions was reduced with the surge of COVID-19 admissions with each pandemic wave [5]. However, there was no evidence for a decrease in the proportions of older adults or those with poorer health status (CCI) during either wave-1 or wave-2 of the COVID-19 pandemic.…”

Section: Patient Characteristicsmentioning

confidence: 88%

“…In addition, we followed the national guidelines with the implementation of surge rota [20], redeployment of staff [21] and deferral of annual leave [22]. Similar to other centres, there was a restructure and expansion of hospital wards such as critical care units [23], and a shift from face-to-face outpatient clinics to telephone clinics [5]. These measures were likely to have a positive impact on overall ability to maintain non-COVID cover.…”

Section: Los and Care-quality Outcomesmentioning

confidence: 99%

“…The coronavirus disease (COVID-19) pandemic had led to an abrupt transformation in healthcare systems [1,2]. There was an urgent need for rapid modification and expansion of hospital ward structures [3,4], mobilisation of healthcare professionals, and reorganisation of medical and surgical provisions [5,6]. Consequently, there was a significant reduction in healthcare service delivery as well as service utilisation [7][8][9][10][11], which particularly affected older adults [12], patients with mental health disorders [13], and individuals of lower socioeconomic status [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Since the beginning of the COVID-19 pandemic, there has been an unprecedented amount of research and publications devoted to the management of COVID-19 patients. However, comparable research on general medical conditions (non-COVID-19) has diminished, although the latter group comprises the majority (almost 90%) of all hospital admissions [5]. There has been a suggestion that many older people were generally discharged more rapidly during the pandemic [16].…”

Section: Introductionmentioning

confidence: 99%

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Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

et al. 2022

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Uncertainties remain if changes to hospital care during the coronavirus disease (COVID-19) pandemic had an adverse impact on the care-quality of non-COVID-19 patients. We examined the association of hospital length of stay (LOS) with healthcare quality indicators in patients admitted with general medical conditions (non-COVID-19). In this retrospective monocentric study at a National Health Service hospital (Surrey), data were collected from 1st April 2019 to 31st March 2021, including the pandemic from 1st March 2020. Primary admissions, in-hospital mortality, post-discharge readmission and mortality were compared between the pre-pandemic (reference group) and pandemic period, according to LOS categories. There were 10,173 (47.7% men) from the pre-pandemic and 11,019 (47.5% men) from the pandemic period; mean (SD) age 68.3 year (20.0) and 68.3 year (19.6), respectively. During the pandemic, primary admission rates for acute cardiac conditions, pulmonary embolism, cerebrovascular accident and malignancy were higher, whilst admission rates for respiratory diseases and common age-related infections, and in-hospital mortality rates were lower. Amongst 19,721 survivors, sex distribution and underlying health status did not significantly differ between admissions before the pandemic and during wave-1 and wave-2 of the pandemic. Readmission rates did not differ between pre-pandemic and pandemic groups within the LOS categories of < 7 and 7–14 days, but were lower for the pandemic group who stayed > 14 days. For patients who died within seven days of admission, in-hospital mortality rates were lower in patients admitted during the pandemic. Mortality rates within 30 days of discharge did not differ between pre-pandemic and pandemic groups, irrespective of the initial hospital LOS. Despite higher rates of admission for serious conditions during the pandemic, in-hospital mortality was lower. Discharge time was similar to that for patients admitted before the pandemic, except it was earlier during the pandemic for those who stayed > 14 days, There were no group differences in quality-care outcomes.

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Section: Patient Characteristicsmentioning

confidence: 64%

Section: Patient Characteristicsmentioning

confidence: 88%

Section: Los and Care-quality Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

et al. 2022

Self Cite

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Impact of the COVID‐19 pandemic on care‐quality outcomes in older adults admitted to hospital with altered mental status

Fluck,

Fry,

Robin

et al. 2024

Int J Geriat Psychiatry

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ObjectivesDuring the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality‐care outcomes, including length of stay (LOS), in‐hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic.MethodsChi‐squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre‐pandemic data, were conducted to examine the impact of the pandemic on outcomes.DesignProspective data of 21,192 non‐COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021).ResultsThere were 10,173 (47.7% men) from the pre‐pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3–16.2] vs 15.5 days [IQR = 6.2–25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12–0.57). In‐hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11–0.96).ConclusionsThis combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission‐discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS.

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High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

et al. 2022

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Risk factors for COVID-19-related outcomes have been variably reported. We used the standardised LACE index to examine admissions and in-hospital mortality associated with COVID-19. Data were collected in the pre-pandemic period (01-04-2019 to 29-02-2020) from 10,173 patients (47.7% men: mean age ± standard deviation = 68.3 years ± 20.0) and in the pandemic period (01-03-2019 to 31-03-2021) from 12,434 patients. With the latter, 10,982 were without COVID-19 (47.4% men: mean age = 68.3 years ± 19.6) and 1452 with COVID-19 (58.5% men: mean age = 67.0 years ± 18.4). Admissions and mortality were compared between pre-pandemic and pandemic patients, according to LACE index. Admission rates rose disproportionately with higher LACE indices amongst the COVID-19 group. Mortality rates amongst the pre-pandemic, pandemic non-COVID-19 and COVID-19 groups with LACE index scores < 4 were 0.7%, 0.5%, 0%; for scores 4–9 were 5.0%, 3.7%, 8.9%; and for scores ≥ 10 were: 24.2%, 20.4%, 43.4%, respectively. The area under the curve receiver operating characteristic for predicting mortality by LACE index was 76% for COVID-19 and 77% for all non-COVID-19 patients. The risk of age and sex-adjusted mortality did not differ from the pre-pandemic group for COVID-19 patients with LACE index scores < 4. However, risk increased drastically for scores from 4 to 9: odds ratio = 3.74 (95% confidence interval = 2.63–5.32), and for scores ≥ 10: odds ratio = 4.02 (95% confidence interval = 3.38–4.77). In conclusion, patients with LACE index scores ≥ 4 have disproportionally greater risk of COVID-19 hospital admissions and deaths, in support of previous studies in patients without COVID-19. However, of importance, our data also emphasise their increased risk in patients with COVID-19. Because the LACE index has a good predictive power of mortality, it should be considered for routine use to identify high-risk COVID-19 patients.

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Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic

Cited by 12 publications

References 23 publications

Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

Does the length of stay in hospital affect healthcare outcomes of patients without COVID-19 who were admitted during the pandemic? A retrospective monocentric study

Impact of the COVID‐19 pandemic on care‐quality outcomes in older adults admitted to hospital with altered mental status

High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

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