Impact of Covid pandemic on surgical care in the Netherlands mapped

In 2020, the number of acute surgical operations in the Netherlands remained stable compared to the years before, despite downscaling healthcare as a consequence of the COVID-19 pandemic. Oncological operations were prioritized, whereby, in general, waiting times for the operations were in fact shorter, as were patients’ hospital stays. Outcomes following the operations, such as the number of complications, proved unchanged in the COVID-19 pandemic year 2020. However, the total planned number of patients who were operated on in 2020 was 13.6% lower than in 2019 and 2018. These are the result of a large study conducted by the Dutch COVIDSurg Collaborative study group led by oncological surgeon Schelto Kruijff from the University Medical Center Groningen (UMCG). The study will be published in the British Journal of Surgery.
Covid patient doctor

To meet the increased demand for ICU capacity for COVID-19 patients during the pandemic, hospitals were forced to downscale regular healthcare. This led to major disruption of regular healthcare, which also affected patients who did not have COVID-19. It is becoming increasingly clear that the COVID-19 pandemic has affected many aspects of healthcare, whereby surgical care is one of the hardest hit sectors.

Surgical quality registries

The Dutch COVIDSurg Collaborative study group, comprising various surgeons from different hospitals in the Netherlands, studied the impact that the COVID-19 pandemic in the Netherlands has had on eight different surgical disciplines. The study was carried out in collaboration with the Dutch Institute for Clinical Auditing (DICA) to compare the surgical care provided in the first pandemic year 2020 with the care provided in the years prior to COVID-19 (2018-2019). A total of 50 hospitals in the Netherlands contributed, which resulted in data from 40,296 patients from various surgical registries being included in the study.

Altered treatment patterns

The study shows, as expected, that the number of patients operated on in 2020 was 13.6% lower compared to 2018 and 2019. The biggest reductions were seen during the first and second COVID-19 waves. The number of acute surgical operations, however, remained stable and in most cases the oncological surgical care continued with shorter waiting times for the operation. The data further show that the average hospital stay for oncological surgical patients was shorter in 2020, without an increase in complications or re-admissions. In addition, a significant reduction was seen in the number of ICU admissions for postoperative surgical patients.

Lessons learned

Despite the lower number of actual operations, downscaling the entire healthcare sector did not lead to an increase in acute surgical care or to poorer results for patients who were operated on in 2020. Oncological patients had shorter hospital stays and fewer postoperative ICU admissions, without increased numbers of re-admissions. According to the researchers, the latter shows that for some operations, for which ICU monitoring after the operation is standard, less intensive monitoring may be possible. This would then be a decision that has to be made on a more individual patient level. With the current ICU staff shortages, more medium-care facilities could be created to enable surgical care to function adequately leading to more remaining t ICU capacity to cope with potential future COVID-19 waves or with other pandemics.