Impact of the COVID-19 pandemic on surgical care in the Netherlands

Michelle R De Graaff; Rianne N M Hogenbirk; Yester F Janssen; Arthur K E Elfrink; Ronald S L Liem; Simon W Nienhuijs; Jean Paul P M De Vries; Jan Willem Elshof; Emiel Verdaasdonk; Jarno Melenhorst; H L Van Westreenen; Marc G H Besselink; Jelle P Ruurda; Mark I Van Berge Henegouwen; Joost M Klaase; Marcel Den Dulk; Mark Van Heijl; Johannes H Hegeman; Jerry Braun; Daan M Voeten; Franka S Würdemann; Anne Loes K Warps; Anna J Alberga; J Annelie Suurmeijer; Erman O Akpinar; Nienke Wolfhagen; Anne Loes Van Den Boom; Marieke J Bolster-van Eenennaam; Peter Van Duijvendijk; David J Heineman; Michel W J M Wouters; Schelto Kruijff; J N Helleman; C L Koningswoud-terhoeve; E Belt; J A B Van Der Hoeven; G M H Marres; F Tozzi; E M Von Meyenfeldt; R R J Coebergh; H.P. Van Den Braak; A M Rijken; R Balm; F Daams; C Dickhoff; W J Eshuis; S S Gisbertz; H R Zandbergen; R H Geelkerken; F R Halfwerk; Dutch CovidSurg Collaborative Study Group

doi:10.1093/bjs/znac301

Impact of the COVID-19 pandemic on surgical care in the Netherlands

Michelle R De Graaff, Rianne N M Hogenbirk, Yester F Janssen, Arthur K E Elfrink, Ronald S L Liem, Simon W Nienhuijs, Jean Paul P M De Vries, Jan Willem Elshof, Emiel Verdaasdonk, Jarno Melenhorst, H L Van Westreenen, Marc G H Besselink, Jelle P Ruurda, Mark I Van Berge Henegouwen, Joost M Klaase, Marcel Den Dulk, Mark Van Heijl, Johannes H Hegeman, Jerry Braun, Daan M VoetenFranka S Würdemann, Anne Loes K Warps, Anna J Alberga, J Annelie Suurmeijer, Erman O Akpinar, Nienke Wolfhagen, Anne Loes Van Den Boom, Marieke J Bolster-van Eenennaam, Peter Van Duijvendijk, David J Heineman, Michel W J M Wouters, Schelto Kruijff^*, J N Helleman, C L Koningswoud-terhoeve, E Belt, J A B Van Der Hoeven, G M H Marres, F Tozzi, E M Von Meyenfeldt, R R J Coebergh, H.P. Van Den Braak, A M Rijken, R Balm, F Daams, C Dickhoff, W J Eshuis, S S Gisbertz, H R Zandbergen, R H Geelkerken, F R Halfwerk, Dutch CovidSurg Collaborative Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background

The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.

Methods

A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.

Results

Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).

Conclusion

The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

Original language	English
Article number	znac301
Pages (from-to)	1282-1292
Number of pages	10
Journal	British journal of surgery
Volume	109
Issue number	12
Early online date	6 Sept 2022
DOIs	https://doi.org/10.1093/bjs/znac301
Publication status	Published - 1 Dec 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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De Graaff, M. R., Hogenbirk, R. N. M., Janssen, Y. F., Elfrink, A. K. E., Liem, R. S. L., Nienhuijs, S. W., De Vries, J. P. P. M., Elshof, J. W., Verdaasdonk, E., Melenhorst, J., Van Westreenen, H. L., Besselink, M. G. H., Ruurda, J. P., Van Berge Henegouwen, M. I., Klaase, J. M., Den Dulk, M., Van Heijl, M., Hegeman, J. H., Braun, J., ... Dutch CovidSurg Collaborative Study Group (2022). Impact of the COVID-19 pandemic on surgical care in the Netherlands. British journal of surgery, 109(12), 1282-1292. Article znac301. https://doi.org/10.1093/bjs/znac301

@article{ca4722c703764671a7b76b9e29720eb7,

title = "Impact of the COVID-19 pandemic on surgical care in the Netherlands",

abstract = "BackgroundThe COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.MethodsA nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.ResultsSome 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).ConclusionThe reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.",

author = "\{De Graaff\}, \{Michelle R\} and Hogenbirk, \{Rianne N M\} and Janssen, \{Yester F\} and Elfrink, \{Arthur K E\} and Liem, \{Ronald S L\} and Nienhuijs, \{Simon W\} and \{De Vries\}, \{Jean Paul P M\} and Elshof, \{Jan Willem\} and Emiel Verdaasdonk and Jarno Melenhorst and \{Van Westreenen\}, \{H L\} and Besselink, \{Marc G H\} and Ruurda, \{Jelle P\} and \{Van Berge Henegouwen\}, \{Mark I\} and Klaase, \{Joost M\} and \{Den Dulk\}, Marcel and \{Van Heijl\}, Mark and Hegeman, \{Johannes H\} and Jerry Braun and Voeten, \{Daan M\} and W{\"u}rdemann, \{Franka S\} and Warps, \{Anne Loes K\} and Alberga, \{Anna J\} and Suurmeijer, \{J Annelie\} and Akpinar, \{Erman O\} and Nienke Wolfhagen and \{Van Den Boom\}, \{Anne Loes\} and \{Bolster-van Eenennaam\}, \{Marieke J\} and \{Van Duijvendijk\}, Peter and Heineman, \{David J\} and Wouters, \{Michel W J M\} and Schelto Kruijff and Helleman, \{J N\} and Koningswoud-terhoeve, \{C L\} and E Belt and \{Van Der Hoeven\}, \{J A B\} and Marres, \{G M H\} and F Tozzi and \{Von Meyenfeldt\}, \{E M\} and Coebergh, \{R R J\} and \{Van Den Braak\}, H.P. and Rijken, \{A M\} and R Balm and F Daams and C Dickhoff and Eshuis, \{W J\} and Gisbertz, \{S S\} and Zandbergen, \{H R\} and Geelkerken, \{R H\} and Halfwerk, \{F R\} and \{Dutch CovidSurg Collaborative Study Group\}",

note = "Lay Summary COVID-19 has had a significant impact on healthcare worldwide. Hospital visits were reduced, operating facilities were used for COVID-19 care, and cancer screening programmes were cancelled. This study describes the impact of the COVID-19 pandemic on Dutch surgical healthcare in 2020. Patterns of care in terms of changed or delayed treatment are described for patients who had surgery in 2020, compared with those who had surgery in 2018–2019. The study found that mainly non-cancer surgical treatments were cancelled during months with high COVID-19 rates. Outcomes for patients undergoing surgery were similar but with fewer ICU admissions and shorter hospital stay. These data provide no insight into the burden endured by patients who had postponed or cancelled operations.",

year = "2022",

month = dec,

day = "1",

doi = "10.1093/bjs/znac301",

language = "English",

volume = "109",

pages = "1282--1292",

journal = "British journal of surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "12",

}

De Graaff, MR, Hogenbirk, RNM, Janssen, YF, Elfrink, AKE, Liem, RSL, Nienhuijs, SW, De Vries, JPPM, Elshof, JW, Verdaasdonk, E, Melenhorst, J, Van Westreenen, HL, Besselink, MGH, Ruurda, JP, Van Berge Henegouwen, MI, Klaase, JM, Den Dulk, M, Van Heijl, M, Hegeman, JH, Braun, J, Voeten, DM, Würdemann, FS, Warps, ALK, Alberga, AJ, Suurmeijer, JA, Akpinar, EO, Wolfhagen, N, Van Den Boom, AL, Bolster-van Eenennaam, MJ, Van Duijvendijk, P, Heineman, DJ, Wouters, MWJM, Kruijff, S, Helleman, JN, Koningswoud-terhoeve, CL, Belt, E, Van Der Hoeven, JAB, Marres, GMH, Tozzi, F, Von Meyenfeldt, EM, Coebergh, RRJ, Van Den Braak, HP, Rijken, AM, Balm, R, Daams, F, Dickhoff, C, Eshuis, WJ, Gisbertz, SS, Zandbergen, HR, Geelkerken, RH , Halfwerk, FR & Dutch CovidSurg Collaborative Study Group 2022, 'Impact of the COVID-19 pandemic on surgical care in the Netherlands', British journal of surgery, vol. 109, no. 12, znac301, pp. 1282-1292. https://doi.org/10.1093/bjs/znac301

TY - JOUR

T1 - Impact of the COVID-19 pandemic on surgical care in the Netherlands

AU - De Graaff, Michelle R

AU - Hogenbirk, Rianne N M

AU - Janssen, Yester F

AU - Elfrink, Arthur K E

AU - Liem, Ronald S L

AU - Nienhuijs, Simon W

AU - De Vries, Jean Paul P M

AU - Elshof, Jan Willem

AU - Verdaasdonk, Emiel

AU - Melenhorst, Jarno

AU - Van Westreenen, H L

AU - Besselink, Marc G H

AU - Ruurda, Jelle P

AU - Van Berge Henegouwen, Mark I

AU - Klaase, Joost M

AU - Den Dulk, Marcel

AU - Van Heijl, Mark

AU - Hegeman, Johannes H

AU - Braun, Jerry

AU - Voeten, Daan M

AU - Würdemann, Franka S

AU - Warps, Anne Loes K

AU - Alberga, Anna J

AU - Suurmeijer, J Annelie

AU - Akpinar, Erman O

AU - Wolfhagen, Nienke

AU - Van Den Boom, Anne Loes

AU - Bolster-van Eenennaam, Marieke J

AU - Van Duijvendijk, Peter

AU - Heineman, David J

AU - Wouters, Michel W J M

AU - Kruijff, Schelto

AU - Helleman, J N

AU - Koningswoud-terhoeve, C L

AU - Belt, E

AU - Van Der Hoeven, J A B

AU - Marres, G M H

AU - Tozzi, F

AU - Von Meyenfeldt, E M

AU - Coebergh, R R J

AU - Van Den Braak, H.P.

AU - Rijken, A M

AU - Balm, R

AU - Daams, F

AU - Dickhoff, C

AU - Eshuis, W J

AU - Gisbertz, S S

AU - Zandbergen, H R

AU - Geelkerken, R H

AU - Halfwerk, F R

AU - Dutch CovidSurg Collaborative Study Group

N1 - Lay Summary COVID-19 has had a significant impact on healthcare worldwide. Hospital visits were reduced, operating facilities were used for COVID-19 care, and cancer screening programmes were cancelled. This study describes the impact of the COVID-19 pandemic on Dutch surgical healthcare in 2020. Patterns of care in terms of changed or delayed treatment are described for patients who had surgery in 2020, compared with those who had surgery in 2018–2019. The study found that mainly non-cancer surgical treatments were cancelled during months with high COVID-19 rates. Outcomes for patients undergoing surgery were similar but with fewer ICU admissions and shorter hospital stay. These data provide no insight into the burden endured by patients who had postponed or cancelled operations.

PY - 2022/12/1

Y1 - 2022/12/1

N2 - BackgroundThe COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.MethodsA nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.ResultsSome 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).ConclusionThe reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

AB - BackgroundThe COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.MethodsA nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.ResultsSome 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).ConclusionThe reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

U2 - 10.1093/bjs/znac301

DO - 10.1093/bjs/znac301

M3 - Article

SN - 0007-1323

VL - 109

SP - 1282

EP - 1292

JO - British journal of surgery

JF - British journal of surgery

IS - 12

M1 - znac301

ER -

Impact of the COVID-19 pandemic on surgical care in the Netherlands

Abstract

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