One in five COVID-19 deaths during delta wave may have resulted from hospital strain
Similar relationships between capacity strain and COVID-19 mortality were seen in both large and small hospitals and those with and without extracorporeal membrane oxygenation capability, an analysis of 2021 data from 620 U.S. facilities found.
Surges in patient volume during the delta wave of COVID-19 were associated with significantly higher inpatient mortality in all types of U.S. hospitals, a recent study found.
The retrospective cohort study looked at 223,380 adult patients with COVID-19 admitted to any of 620 U.S. hospitals in July to November 2021. The hospitals were classified into four types: 208 had extracorporeal membrane oxygenation (ECMO) capability, 216 had multiple ICUs, 36 had a single ICU but at least 200 beds, and 160 had one ICU and fewer than 200 beds. Surge was assessed using a previously validated index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity). Results were published by Annals of Internal Medicine on Sept. 10.
Overall, 23% of the patients required admission to the ICU and 15.3% died. The marginally adjusted probability for mortality was 5.51% (95% CI, 4.53% to 6.50%) per unit increase in the log surge index. The researchers calculated that approximately 7,375 (95% CI, 5,936 to 8,813) COVID-19 patient deaths, or one in five, could be attributed to hospital strain. A test for interaction found no difference among the four hospital types in the relationship between surge and mortality. Results were also consistent when transferred patients were excluded, when only patients requiring mechanical ventilation at admission were included, and when alternative metrics for strain were used.
The study authors highlighted two key findings: first, that “substantially detrimental effects of hospital overcrowding on survival from COVID-19 identified early in the pandemic persisted well beyond the pandemic's ‘learning curve,’” and second, that the association between strain and mortality affected hospitals regardless of their infrastructure.
“The main take home from these findings is that avoiding surging caseload across the spectrum of hospital types might be lifesaving,” the study authors wrote, noting that the association may also apply to the more recent problem of staff shortages. “These findings underscore the importance of strategic redistribution of patients between hospitals during public health emergencies, including routine surges, so U.S hospitals already struggling amid staffing crisis have mechanisms for decompression and personnel redistribution.”
