The negative impact of hospital saturation on non-COVID-19 hospital mortality during the pandemic in France: a national population-based cohort study on 2,264,871 patients (Preprint)
Authors: Boyer Laurent , Pauly Vanessa , Brousse Yann , Orleans Veronica , Tran Bach , Yon Dong Keon , Auquier Pascal , Fond Guillaume , Duclos Antoine 
Published: August 2023

BACKGROUND

A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France.

OBJECTIVE

We aimed to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital mortality during the first year of the pandemic in France.

METHODS

We conducted a nationwide population-based cohort study including all adult patients hospitalized for non-COVID-19 acute medical conditions in France from March 1, 2020, to December 31, 2020. Hospital saturation was categorized into four levels based on weekly bed occupancy for COVID-19: no saturation (<5%), low saturation (>5% and ≤15%), moderate saturation (>15% and ≤30%), and high saturation (>30%). Multivariate generalized linear model analyzed the association between hospital saturation and mortality. Statistical interactions were investigated to identify subgroups of patients who would be more affected by hospital saturation.

RESULTS

A total of 2,264,871 adult patients were hospitalized for acute medical conditions. Hospital mortality was found to be higher in hospitals with high saturation (7.02%) compared to hospitals with no saturation (5.30%). In the multivariate analysis, the hospital mortality was significantly higher in low saturated hospitals (adjusted odds ratio [aOR]=1.05, 95% CI [1.34-1.07], p<0.001), moderate saturated hospitals (aOR=1.12, 95% CI [1.09-1.14], p<0.001), and highly saturated hospitals (aOR=1.25, 95% CI [1.21-1.30], p<0.001). The negative impact of hospital saturation on mortality was more pronounced in patients older than 65 years, those with fewer comorbidities (Charlson 1-2 and 3 vs. 0), patients with cancer, nervous and mental diseases, those admitted from home or through the emergency room (compared to transfers from other hospital wards), and those not admitted to the intensive care unit. High saturated hospitals had a lower proportion of patients receiving care for cancer (9.8% vs. 13.0%) and circulatory diseases (19.9% vs. 22.8%) compared to non-saturated hospitals.

CONCLUSIONS

The findings indicate that hospital saturation during the pandemic led to a significant increase in mortality for medical conditions. Our study uncovers a striking “dose-effect” relationship: as hospital saturation intensifies, so does the mortality risk. These results raise concerns regarding hospitals' resilience and patient safety, underscoring the importance of identifying targeted strategies to enhance resilience for the future, particularly for high-risk patients.

CLINICALTRIAL

The study was approved for ethical considerations by the French National Data Protection Commission (No. F20211214152715: https://www.health-data-hub.fr/projets/etude-en-vie-reelle-de-limpact-de-la-pandemie-covid-19-sur-lacces-et-la-qualite-de-la-prise).