ABSTRACT
BackgroundInternationally, the Coronavirus Disease (COVID-19) pandemic has caused unprecedented challenges for surgical staff to minimise the exposure to COVID-19 or save medical resources without harmful outcomes for patients, in accordance with the statement of each surgical society. However, no research has empirically validated declines in Japanese surgical volume or compared decrease rates of surgeries during the COVID-19 pandemic. Material and MethodsWe extracted 672,772 available cases of patients aged > 15 years who were discharged between July 1, 2018, and June 30, 2020. After categorisation of surgery, we calculated descriptive statistics to compare the year-over-year trend and conducted interrupted time series analysis to validate the decline. ResultsThe year-over-year trend of all eight surgical categories decreased from April 2020 and reached a minimum in May 2020 (May: abdominal, 68.4%; thoracic, 85.8%; genitourinary, 78.6%; cardiovascular, 90.8%; neurosurgical, 69.1%; orthopaedic, 62.4%; ophthalmologic, 52.0%; ear/nose/throat, 27.3%). Interrupted time series analysis showed no significant trends in oncological and critical benign surgeries. ConclusionWe demonstrated and validated a trend of reduction in surgical volume in Japan using administrative data applying interrupted time series analyses. Low priority surgeries, as categorised by the statement of each society, showed obvious and statistically significant declines in case volume during the COVID-19 pandemic.
Subject(s)
COVID-19 , Coronavirus Infections , Pulmonary Disease, Chronic ObstructiveABSTRACT
Background: Recent researches reported the impact of the coronavirus disease 2019 (COVID - 19) pandemic on the clinical practice of specific type cancers. The aim of this study was to reveal the impact of the COVID-19 outbreak on the clinical practice of various cancers. Methods: We included hospitalized patients aged 18 years or older diagnosed between July 2018 and June 2020 with one of the top 12 most common cancers in Japan (colon/rectum, lung, gastric, breast, bladder & urinary tract, pancreas, non-Hodgkin lymphoma, liver, prostate, esophagus, uterus, and gallbladder & biliary tract) using Diagnostic Procedure Combination data, an administrative database in Japan. The intervention was defined April 2020 based on a declaration of emergency from Japanese government. The change volume of number of monthly admissions with each cancer was tested by interrupted time series (ITS) analysis, and monthly cases with radical surgery or chemotherapy for each cancer were descripted. Results: 403,344 cases were included during the study period. The most common cancer was colon/rectum (20.5%), followed by lung (17.5%). In almost cancer cases, the number of admissions decreased in May 2020. In particular, colorectal, lung, gastric, breast, uterine, or esophageal cancer cases decreased by over 10%. The number of admissions with surgery or chemotherapy decreased in colorectal, lung, gastric, breast, uterine, or esophageal cancer. ITS analysis indicated that cases with gastric or esophageal cancer were affected more than other type of cancer. Conclusions: The COVID-19 outbreak has a negative impact on the number of admission cases with cancer; the magnitude of impact varied by cancer diagnosis.
Subject(s)
Esophageal Neoplasms , Lymphoma, Non-Hodgkin , Neoplasms , Breast Neoplasms , COVID-19 , Colorectal NeoplasmsABSTRACT
Background During the coronavirus disease 2019 (COVID-19) pandemic, there have been health concerns related to alcohol use and misuse. Therefore, the World Health Organization cautioned that alcohol consumption during the pandemic might have a negative impact. The aim of this study was to examine the population-level change in cases of alcohol-related liver disease and pancreatitis that required admission during the COVID-19 outbreak. Methods We included patients aged 18 years or older who were hospitalized between July 2018 and June 2020 using Diagnostic Procedure Combination data, an administrative database in Japan, and counted the admission cases whose primary diagnosis was alcohol-related liver disease or pancreatitis. We defined the period from April 2020, when the Japanese government declared a state of emergency, as the beginning of the COVID-19 outbreak. The rate ratio (RR) of admissions with alcohol-related liver disease or pancreatitis per 1,000 admissions was tested using interrupted time series analysis. In addition, excess admissions for alcohol-related liver disease or pancreatitis were calculated. Results Overall admissions were 3,026,389 cases, and a total of 10,242 admissions for alcohol-related liver disease or pancreatitis occurred from 257 hospitals. The rate of admissions per 1,000 admissions during the COVID-19 outbreak period (April 2020 to June 2020) had a 1.2 times increase compared with the pre-outbreak period (July 2018 to March 2020) for cases of alcohol-related liver disease or pancreatitis (RR: 1.22, 95%Confidence interval [CI]: 1.12 to 1.33). The COVID-19 pandemic caused about 214.75 (95%CI: 178.78 to 249.72) excess admissions for alcohol-related liver disease or pancreatitis based on predictions from our model. Conclusion The COVID-19 outbreak might have resulted in increased hospital admissions for alcohol-related liver disease or pancreatitis.
Subject(s)
COVID-19 , Pancreatitis , Liver DiseasesABSTRACT
Background In response to the coronavirus diseases 2019 (COVID-19) pandemic, the Japanese government declared a state of emergency on April 7, 2020. Six days earlier, the Japan Surgical Society had recommended postponing elective surgical procedures. Along with the growing public fear of COVID-19, hospital visits in Japan decreased. Methods Using claims data from the Quality Indicator/Improvement Project (QIP) database, this study aimed to clarify the impact of the first wave of the pandemic, considered to be from March to May 2020, on case volume and claimed hospital charges in acute care hospitals during this period. To make year-over-year comparisons, we considered cases from July 2018 to June 2020. Results A total of 2,739,878 inpatient and 53,479,658 outpatient cases from 195 hospitals were included. In the year-over-year comparisons, total claimed hospital charges decreased in April, May, June 2020 by 7%, 14%, and 5%, respectively, compared to the same months in 2019. Our results also showed that per-case hospital charges increased during this period, possibly to compensate for the reduced case volumes. Regression results indicated that the hospital charges in April and May 2020 decreased by 6.3% for hospitals without COVID-19 patients. For hospitals with COVID-19 patients, there was an additional decrease in proportion with the length of hospital stay of COVID-19 patients including suspected cases. The mean additional decrease per COVID-19 patients was estimated to 5.5 million JPY. Conclusion It is suggested that the hospitals treating COVID-19 patients were negatively incentivized.