The impact of the COVID‐19 pandemic on longitudinal trends of surgical mortality and inpatient quality of care in Ontario, Canada

Abstract

AbstractAimsPrevious studies have shown the COVID‐19 pandemic was associated with reductions in volume across a spectrum of non‐SARS‐CoV‐2 hospitalizations. In the present study, we examine the impact of the pandemic on patient safety and quality of care.DesignThis is a retrospective population‐based study of discharge abstracts.MethodsWe applied a set of nationally validated indicators for measuring the quality of inpatient care to hospitalizations in Ontario, Canada between January 2010 and December 2022. We measured 90‐day mortality after selected types of higher risk admissions (such as cancer surgery and cardiovascular emergency) and the rate of patient harm events (such as delirium, pressure injuries and hospital‐acquired infections) occurring during the hospital stay.ResultsA total 13,876,377 hospitalization episodes were captured. Compared with the pre‐pandemic period, and independent of SARS‐CoV‐2 infection, the pandemic period was associated with higher rates of mortality after bladder cancer resection (adjusted risk ratio [aRR] 1.20 (1.07–1.34)) and open repair for abdominal aortic aneurysm (aRR 1.45 (1.06–1.99)). The pandemic was also associated with higher rates of delirium (adjusted odds ratio [aOR] 1.04 (1.02–1.06)), venous thromboembolism (aOR 1.10 (1.06–1.13)), pressure injuries (aOR 1.28 (1.24–1.33)), aspiration pneumonitis (aOR 1.15 (1.12–1.18)), urinary tract infections (aOR 1.02 (1.01–1.04)), Clostridiodes difficile infection (aOR 1.05 (1.02–1.09)), pneumothorax (aOR 1.08 (1.03–1.13)), and use of restraints (aOR 1.12 (1.10–1.14)), but was associated with lower rates of viral gastroenteritis (aOR 0.22 (0.18–0.28)). During the pandemic, SARS‐CoV‐2‐positive admissions were associated with a higher likelihood of various harm events.ConclusionThe COVID‐19 pandemic was associated with higher rates of patient harm for a wide range of non‐SARS‐CoV‐2 inpatient populations.ImpactUnderstanding which quality measures are improving or deteriorating can help health systems prioritize quality improvement initiatives.Patient or Public ContributionNo patient or public contribution.