The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

Abstract

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…1 : General health services include different levels of care or type of service; 2 : aggregated data and/or no specification of the different periods of analysis; 3 : studies that did not analyze whether the changes were statistically significant (the rest of articles presented results statistically significant); AF: associated factors; ED: emergency department; ICU: intensive care unit; IRR: incidence rate ratio; OB-GYN: obstetrics-gynecology; OR: odds ratio; PC: primary care; RR: relative risk; SC: secondary care; SRH: sexual and reproductive health. With regard to the type of service, of the studies on realized access, 5 focused on health services in general [46][47][48][49][50]; 12 on emergencies [51][52][53][54][55][56][57][58][59][60][61][62] (of which 5 were related to pediatric emergencies [56][57][58]60,61]); 15 on secondary care (SC) (outpatient visits, hospital admissions, etc., for nephrology [63], oncology [64,65], pediatrics [66], psychiatry [67,68], rehabilitation [69], respiratory diseases [70], sexual and reproductive health (SRH) [71,[73][74][75], and traumatology [78,79]); two on primary care (PC) [80,81]; one on preventive services…”

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

“…With regard to the period of analysis, 38 of the selected studies were conducted over the first months of the pandemic (February to June 2020) [46][47][48][49][50][51][52][53][54][55][57][58][59][60]62,[65][66][67][68][69][70][72][73][74][75][76][77][78][79][80]82,84,86,88,90,92,93,98]; 4 during the second stage of the pandemic (June to September 2020) [85,89,91,96]; 1 at a later stage (September to November 2020) [94]; finally, 8 analyzed the whole period (February to December 2020) [56,61,63,64,71,…”

“…No studies were found that analyzed periods after December 2020. All studies that analyzed realized access presented their results in comparison with a previous period: 32 of the first-stage studies compared the changes to pre-pandemic periods of reference [46][47][48][49][50][51][52][53][54][55][57][58][59][60]62,[65][66][67][68][69][70][72][73][74][75][76][77][78][79][80]82,98], as did 6 of those that analyzed the whole period [56,61,63,64,71,83]. One study did not specify the exact period of 2020 analyzed [95].…”

“…By type of service analyzed, studies focusing on the health services in general [46,47,49,50] described an overall drop in use, which varied in terms of magnitude. Among those that analyzed changes in emergency care [51][52][53][54][55][56][57][58][59][60][61][62]66,77], it was reported that, although the volume of consultations fell, there was an increase in the number of cases with additional complications [53,58,66,74,77] and cases requiring admission to hospital [51,55,57,59,60,67,70]. Likewise, the studies on changes in SC services also reported a reduction in the use of services, while in some cases detecting an increase in the proportion of visits or hospital admissions in concrete healthcare areas (e.g., severe mental health cases [47] or trauma injuries [56,58,78]).…”