Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland - A Retrospective Study Based on Insurance Claims Data.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease 2019 (COVID-19), yet the impact on elective and emergency inpatient procedure volumes is unclear. METHODS: We analyzed anonymized data on 234 921 hospitalizations in 2017-2020 (55.9% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre-pandemic data, the expected weekly numbers of procedures in 2020 in the absence of a pandemic and compared these to the observed numbers in 2020. Compensation effects were investigated by discretely integrating the difference between the two numbers over time. RESULTS: During the first COVID-19 wave in spring 2020, elective procedure numbers decreased by 52.9% (95% confidence interval -64.5% to -42.5%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by 45.5% and 72.4%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of -9.9% (-15.8% to -4.5%) for the whole year 2020. Emergency procedure numbers also decreased by 17.1% (-23.7% to -9.8%) during the first wave, but over the whole year 2020, net emergency procedure volumes were similar to control years. CONCLUSION: Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non-COVID-19 related care is maintained during future pandemic phases in order to prevent negative health consequences.

Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications.

PURPOSE: Delay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR. METHODS: In a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute's joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables. RESULTS: Two thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1-4.5%, p < 0.001), surgical complications (3.2-1.9%, p < 0.001), internal complications (1.8-1.2% p < 0.041) and transfusion rate (2.6-1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18-1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14-2.00); p = 0.04]. CONCLUSION: Alike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

A Delphi study on the supply risk-mitigating effect of additive manufacturing during SARS-COV-2

Procurement has faced major challenges due to the collapse of global supply chains in the course of the SARS-COV2 pandemic, and non-critical items have become critical bottlenecks. Additive manufacturing (AM) is an emerging technology that serves as a local supply source and can mitigate some of these bottlenecks. For example, it was possible to source medical spare parts and protective equipment via AM, even when the globally arranged traditional (formative or subtractive manufacturing) supply sources failed. To that end, this research examines how supply risks change when sourced via an AM supply source rather than through supply sources that use traditional manufacturing (TM). This study assesses supply risk using a Delphi study from July to October 2020. The findings were further explored using discriminant analysis. A mix of TM supply sources with AM (‘hedging’) can minimise the overall supply risks. The discussion conceptualises a portfolio model to determine whether to source demands via TM, AM, or by hedging. The implications of hedged manufacturing are linked to the modern portfolio theory.

Covid-19 attacks the body of purchasing and supply management: A medical check of the immune system

Much like the immune system of the body, the ‘immune system’ of purchasing and supply management (PSM) is also affected by the Covid-19 virus. Medicine must hinder the spread of the virus and outbreak of disease, just as PSM must prevent risk events and handle supply disruptions. The existing debate on supply resilience and robustness can be demonstrated using this medical analogy. The purpose of this article was to perform a medical check of the ‘PSM immune system’ to identify lessons and research gaps when confronted with a low-frequency-high-impact event such as the pandemic. As a provocative note, this article identifies research gaps in elements of the immune system of PSM (e.g., helper cells – consultancy support or memory cells – feedback loops). The results call for a more holistic debate on the immune system of PSM. Two approaches for research on ‘conventional’ or ‘alternative’ risk management schools of thought are presented as a basis for future discourse on how to improve the PSM immune system.

Point-of-care bulk testing for SARS-CoV-2 by combining hybridization capture with improved colorimetric LAMP.

Efforts to contain the spread of SARS-CoV-2 have spurred the need for reliable, rapid, and cost-effective diagnostic methods which can be applied to large numbers of people. However, current standard protocols for the detection of viral nucleic acids while sensitive, require a high level of automation and sophisticated laboratory equipment to achieve throughputs that allow whole communities to be tested on a regular basis. Here we present Cap-iLAMP (capture and improved loop-mediated isothermal amplification) which combines a hybridization capture-based RNA extraction of gargle lavage samples with an improved colorimetric RT-LAMP assay and smartphone-based color scoring. Cap-iLAMP is compatible with point-of-care testing and enables the detection of SARS-CoV-2 positive samples in less than one hour. In contrast to direct addition of the sample to improved LAMP (iLAMP), Cap-iLAMP prevents false positives and allows single positive samples to be detected in pools of 25 negative samples, reducing the reagent cost per test to ~1 Euro per individual.

A direct RT-qPCR approach to test large numbers of individuals for SARS-CoV-2.

SARS-CoV-2 causes substantial morbidity and mortality in elderly and immunocompromised individuals, particularly in retirement homes, where transmission from asymptomatic staff and visitors may introduce the infection. Here we present a cheap and fast screening method based on direct RT-qPCR to detect SARS-CoV-2 in single or pooled gargle lavages ("mouthwashes"). This method detects individuals with large viral loads (Ct≤29) and we use it to test all staff at a nursing home daily over a period of three weeks in order to reduce the risk that the infection penetrates the facility. This or similar approaches can be implemented to protect hospitals, nursing homes and other institutions in this and future viral epidemics.