Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

Abstract

Few studies have assessed the impact of the COVID-19 pandemic on non-COVID diseases and healthcare quality. We aimed to evaluate changes in rates of hospitalisations, complications, in-hospital mortality, and readmissions among patients with non-COVID diseases during a one-year period after the pandemic onset. From March 2018 to February 2021 a retrospective observational study of hospital admissions in a university hospital in Spain was conducted. Non-COVID hospitalisations admitted through the emergency department were compared between the pre-COVID period (n = 28,622) and the COVID period (n = 11,904). We assessed rate ratios (RaR), comparing the weekly number of admissions and risk ratios (RR) to examine rates of complications, in-hospital mortality, readmissions, and severity. Statistical significance was set at p < 0.05. The weekly admission rate dropped by 20.8% during the complete lockdown. We observed significant reductions in admissions related to diseases of the respiratory system and circulatory system. Admissions for endocrine and metabolic diseases increased. The complication rates increased (RR = 1.21, 95% CI: 1.05;1.4), while in-hospital mortality rates held steady during the COVID period (RR = 1.09, 95% CI: 0.98;1.2). Hospital efforts to maintain quality and safety standards despite disruptions translated into a moderate increase in complications but not in in-hospital mortality. Reduced hospitalisations for conditions requiring timely treatment may have significant public health consequences.

Effect of the COVID-19 pandemic on clinical characteristics and outcomes of adult pneumococcal meningitis patients – a Dutch prospective nationwide cohort study

“…Fourth, in our cohort we found more patients with persistent fever and seizures, which could not only be attributed to more severe clinical presentation at admission, but also reduced quality of care. More in-hospital complications -but not increasing mortality -was earlier described in non-COVID-19 patients during the first year of the pandemic [3]. Similarly, worse outcomes in 2020-2021 may also be related to hospitalrelated factors.…”

“…

including fewer non-COVID-19 hospitalisations [3,4]. It is not known if and how the pandemic affected clinical characteristics and outcomes of specific diseases, e.g.

…”

Exploring the Experiences of Health Care Providers and Managers in the COVID-19 Pandemic: A Summative Content Analysis

“…The COVID-19 pandemic led to nonurgent services for non-COVID-19 patients being postponed in some countries (13). The results of a Spanish study showed the average weekly admission rate decreased by 20.8% during the COVID-19 pandemic (14). In the present study, some vulnerable groups such as pregnant women were affected following the increasing load of COVID-19 patients, and in some cases, the lack or delay of medical services for non-coronavirus patients was reported.…”

What happened to non-SARS-CoV-2 respiratory diseases during the pandemic?

“…In a Danish study, Bodilsen et al 2 observed that hospital admissions for all groups of non-COVID-19 diseases decreased when compared with the periods prior to the pandemic, and, additionally, mortality rates were higher for conditions such as chronic respiratory diseases, cancer, pneumonia, and sepsis, especially during lockdown periods. Domingo et al 3 also observed a significant reduction in hospital admissions mainly related to respiratory and cardiovascular diseases in Spain.…”