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

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...

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Autores principales:	Paul Truche, Letícia Nunes Campos, Enzzo Barrozo Marrazzo, Ayla Gerk Rangel, Ramon Bernardino, Alexis N Bowder, Alexandra M Buda, Isabella Faria, Laura Pompermaier, Henry E. Rice, David Watters, Fernanda Lage Lima Dantas, David P. Mooney, Fabio Botelho, Rodrigo Vaz Ferreira, Nivaldo Alonso
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	COVID-19 Global health Health policy Surgery Elective surgery Emergency surgery Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/f3e0416430fb434b9b233a1da056f88f
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spelling	oai:doaj.org-article:f3e0416430fb434b9b233a1da056f88f2021-11-12T04:50:23ZAssociation between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study2667-193X10.1016/j.lana.2021.100056https://doaj.org/article/f3e0416430fb434b9b233a1da056f88f2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2667193X2100048Xhttps://doaj.org/toc/2667-193XBackground: 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.Paul TrucheLetícia Nunes CamposEnzzo Barrozo MarrazzoAyla Gerk RangelRamon BernardinoAlexis N BowderAlexandra M BudaIsabella FariaLaura PompermaierHenry E. RiceDavid WattersFernanda Lage Lima DantasDavid P. MooneyFabio BotelhoRodrigo Vaz FerreiraNivaldo AlonsoElsevierarticleCOVID-19Global healthHealth policySurgeryElective surgeryEmergency surgeryPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Americas, Vol 3, Iss , Pp 100056- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 Global health Health policy Surgery Elective surgery Emergency surgery Public aspects of medicine RA1-1270
spellingShingle	COVID-19 Global health Health policy Surgery Elective surgery Emergency surgery Public aspects of medicine RA1-1270 Paul Truche Letícia Nunes Campos Enzzo Barrozo Marrazzo Ayla Gerk Rangel Ramon Bernardino Alexis N Bowder Alexandra M Buda Isabella Faria Laura Pompermaier Henry E. Rice David Watters Fernanda Lage Lima Dantas David P. Mooney Fabio Botelho Rodrigo Vaz Ferreira Nivaldo Alonso Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
description	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.
format	article
author	Paul Truche Letícia Nunes Campos Enzzo Barrozo Marrazzo Ayla Gerk Rangel Ramon Bernardino Alexis N Bowder Alexandra M Buda Isabella Faria Laura Pompermaier Henry E. Rice David Watters Fernanda Lage Lima Dantas David P. Mooney Fabio Botelho Rodrigo Vaz Ferreira Nivaldo Alonso
author_facet	Paul Truche Letícia Nunes Campos Enzzo Barrozo Marrazzo Ayla Gerk Rangel Ramon Bernardino Alexis N Bowder Alexandra M Buda Isabella Faria Laura Pompermaier Henry E. Rice David Watters Fernanda Lage Lima Dantas David P. Mooney Fabio Botelho Rodrigo Vaz Ferreira Nivaldo Alonso
author_sort	Paul Truche
title	Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
title_short	Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
title_full	Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
title_fullStr	Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
title_full_unstemmed	Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study
title_sort	association between government policy and delays in emergent and elective surgical care during the covid-19 pandemic in brazil: a modeling study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/f3e0416430fb434b9b233a1da056f88f
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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

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