Impact of the COVID-19 pandemic on surgical care in the Netherlands
Authors: de Graaff Michelle R , Hogenbirk Rianne N M , Janssen Yester F , Elfrink Arthur K E , Liem Ronald S L , Nienhuijs Simon W , de Vries Jean-Paul P M , Elshof Jan-Willem , Verdaasdonk Emiel , Melenhorst Jarno , van Westreenen H L , Besselink Marc G H , Ruurda Jelle P , van Berge Henegouwen Mark I , Klaase Joost M , den Dulk Marcel , van Heijl Mark , Hegeman Johannes H , Braun Jerry , Voeten Daan M , Würdemann Franka S , Warps Anne-Loes K , Alberga Anna J , Suurmeijer J Annelie , Akpinar Erman O , Wolfhagen Nienke , van den Boom Anne Loes , Bolster-van Eenennaam Marieke J , van Duijvendijk Peter , Heineman David J , Wouters Michel W J M , Kruijff Schelto ,   Dutch CovidSurg Collaborative Study Group, Helleman J N , Koningswoud-Terhoeve C L , Belt E , van der Hoeven J A B , Marres G M H , Tozzi F , von Meyenfeldt E M , Coebergh-van den Braak R R J , Huisman S , Rijken A M , Balm R , Daams F , Dickhoff C , Eshuis W J , Gisbertz S S , Zandbergen H R , Hartemink K J , Keessen S A , Kok N F M , Kuhlmann K F D , van Sandick J W , Veenhof A A , Wals A , van Diepen M S , Schoonderwoerd L , Stevens C T , Susa D , Bendermacher B L W , Olofsen N , van Himbeeck M , de Hingh I H J T , Janssen H J B , Luyer M D P , Nieuwenhuijzen G A P , Ramaekers M , Stacie R , Talsma A K , Tissink M W , Dolmans D , Berendsen R , Heisterkamp J , Jansen W A , de Kort-van Oudheusden M , Matthijsen R M , Grünhagen D J , Lagarde S M , Maat A P W M , van der Sluis P C , Waalboer R B , Brehm V , van Brussel J P , Morak M , Ponfoort E D , Sybrandy J E M , Klemm P L , Lastdrager W , Palamba H W , van Aalten S M , Tseng L N L , van der Bogt K E A , de Jong W J , Oosterhuis J W A , Tummers Q , van der Wilden G M , Ooms S , Pasveer E H , Veger H T C , Molegraafb M J , Nieuwenhuijs V B , Patijn G A , van der Veldt M E V , Boersma D , van Haelst S T W , van Koeverden I D , Rots M L , Bonsing B A , Michiels N , Bijlstra O D , Braun J , Broekhuis D , Brummelaar H W , Hartgrink H H , Metselaar A , Mieog J S D , Schipper I B , de Steur W O , Fioole B , Terlouw E C , Biesmans C , Bosmans J W A M , Bouwense S A W , Clermonts S H E M , Coolsen M M E , Mees B M E , Schurink G W H , Duijff J W , van Gent T , de Nes L C F , Toonen D , Beverwijk M J , van den Hoed E , Keizers B , Kelder W , Keller B P J A , Pultrum B B , van Rosum E , Wijma A G , van den Broek F , Leclercq W K G , Loos M J A , Sijmons J M L , Vaes R H D , Vancoillie P J , Consten E C J , Jongen J M J , Verheijen P M , van Weel V , Arts C H P , Jonker J , Murrmann-Boonstra G , Pierie J P E N , Swart J , van Duyn E B , Geelkerken R H , de Groot R , Moekotte N L , Stam A , Voshaar A , van Acker G J D , Bulder R M A , Swank D J , Pereboom I T A , Hoffmann W H , Orsini M , Blok J J , Lardenoije J H P , Reijne M M P J , van Schaik P , Smeets L , van Sterkenburg S M M , Harlaar N J , Mekke S , Verhaakt T , Cancrinus E , van Lammeren G W , Molenaar I Q , van Santvoort H C , Vos A W F , Schouten- van der Velden A P , Woensdregt K , Mooy-Vermaat S P , Scharn D M , Marsman H A , Rassam F , Halfwerk F R , Andela A J , Buis C I , van Dam G M , ten Duis K , van Etten B , Lases L , Meerdink M , de Meijer V E , Pranger B , Ruiter S , Rurenga M , Wiersma A , Wijsmuller A R , Albers K I , van den Boezem P B , Klarenbeek B , van der Kolk B M , van Laarhoven C J H M , Matthée E , Peters N , Rosman C , Schroen A M A , Stommel M W J , Verhagen A F T M , van der Vijver R , Warlé M C , de Wilt J H W , van den Berg J W , Bloemert T , de Borst G J , van Hattum E H , Hazenberg C E V B , van Herwaarden J A , van Hillegerberg R , Kroese T E , Petri B J , Toorop R J , Aarts F , Janssen R J L , Janssen-Maessen S H P , Kool M , Verberght H , Moes D E , Smit J W , Wiersema A M , Vierhout B P , de Vos B , den Boer F C , Dekker N A M , Botman J M J , van Det M J , Folbert E C , de Jong E , Koenen J C , Kouwenhoven E A , Masselink I , Navis L H , Belgers H J , Sosef M N , Stoot J H M B 
Published: October 2022

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 &lt; 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P &lt; 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P &lt; 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.