Hospital Admission Rates, Length of Stay and In-hospital Mortality for Common Acute Care Conditions in COVID-19 vs. Pre-COVID-19 Era

Background Impact of COVID-19 upon acute care admission rates and patterns are unknown. We sought to determine the change in rates and types of admissions to tertiary and specialty care hospitals in the COVID-19 era compared with pre-COVID-19 era. Methods Acute care admissions to the largest tertiary care referral hospital, designated national referral centers for cardiac, cancer and maternity hospital in the State of Qatar during March 2020 (COVID-19 era) and January 2020 and March 2019 (pre-COVID-19 era) were compared. We calculated total admissions, and admissions for eight specific acute care conditions, in-hospital mortality rate and length of stay at each hospital. Results A total of 18,889 hospital admissions were recorded. A sharp decline ranging from 9%-75% was observed in overall admissions. A decline in both elective and non-elective surgeries was observed. A decline of 9%-58% was observed in admissions for acute appendicitis, acute coronary syndrome, stroke, bone fractures, cancer and live births, while an increase in admissions due to respiratory tract infections was observed. Overall length of stay was shorter in the COVID-19 period possibly suggesting lesser overall disease severity, with no significant change in in-hospital mortality. Unadjusted mortality rate for Qatar showed marginal increase in the COVID-19 period. Conclusions We observed a sharp decline in acute care hospital admissions, with a significant decline in admissions due to seven out of eight acute care conditions. This decline was associated with a shorter length of stay, but not associated with a change in in-hospital mortality rate.
Highlights • The change in rate and types of admissions to acute care hospitals during the COVID-19 era compared with pre-COVID-19 era is unknown. • We observed a sharp decline in overall admission volumes and in seven of eight common diagnostic categories, while observing an increase in respiratory infections when comparing COVID-19 vs. pre-COVID-19 timeframe. • A statistically non-significant decrease in in-hospital mortality was observed, while the national statistics demonstrated a slight increase in mortality rate in the country. • It is critical to determine whether there is an association between declining acute care admissions and overall mortality rate in the community, and whether a surge of patients with more advanced disease may be anticipated after COVID-19 related restrictions are removed.