Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study

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Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study


JournalThe Lancet Regional Health – Americas
Article typeJournal research article – Clinical research
Publication date – Aug – 2021
Authors – Paul Truchea, Letícia Nunes Campos, Enzzo Barrozo Marrazzo, Ayla Gerk Rangel, Ramon Bernardino, Alexis N Bowder, Alexandra M Buda, Isabella Faria, Laura Pompermaier, Henry E. Ricef, David Watters, Fernanda Lage Lima Dantas, David P. Mooneyi, Fabio Botelhoj, Rodrigo Vaz Ferreira, Nivaldo Alonso
Keywordscovid-19, elective surgery, emergency surgery, Global Health, health policy, Pandemics, surgery
Open access – Yes
SpecialityCritical care, Emergency surgery, General surgery, Health policy
World region South America
Country: Brazil
Language – English
Submitted to the One Surgery Index on September 2, 2021 at 5:48 am
Abstract:

Background
The impact of public health policy to reduce the spread of COVID-19 on access to surgical care is poorly defined. We aim to quantify the surgical backlog during the COVID-19 pandemic in the Brazilian public health system and determine the relationship between state-level policy response and the degree of state-level delays in public surgical care.

Methods
Monthly estimates of surgical procedures performed per state from January 2016 to December 2020 were obtained from Brazil’s Unified Health System Informatics Department. Forecasting models using historical surgical volume data before March 2020 (first reported COVID-19 case) were constructed to predict expected monthly operations from March through December 2020. Total, emergency, and elective surgical monthly backlogs were calculated by comparing reported volume to forecasted volume. Linear mixed effects models were used to model the relationship between public surgical delivery and two measures of health policy response: the COVID-19 Stringency Index (SI) and the Containment & Health Index (CHI) by state.

Findings
Between March and December 2020, the total surgical backlog included 1,119,433 (95% Confidence Interval 762,663–1,523,995) total operations, 161,321 (95%CI 37,468–395,478) emergent operations, and 928,758 (95%CI 675,202–1,208,769) elective operations. Increased SI and CHI scores were associated with reductions in emergent surgical delays but increases in elective surgical backlogs. The maximum government stringency (score = 100) reduced emergency delays to nearly zero but tripled the elective surgical backlog.

Interpretation
Strong health policy efforts to contain COVID-19 ensure minimal reductions in delivery of emergent surgery, but dramatically increase elective backlogs. Additional coordinated government efforts will be necessary to specifically address the increased elective backlogs that accompany stringent responses.

OSI Number – 21240

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