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Groin Hernia Repair during the COVID-19 Pandemic-A Romanian Nationwide Analysis
Nicolae Dragos Garofil1, Mircea Nicolae Bratucu1, Mihai Zurzu1
1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Insights
The COVID-19 pandemic significantly reduced groin hernia repair surgeries in Romania, but the private sector saw an increase. Public hospitals experienced longer mean admission periods compared to private facilities.
Area of Science:
- Health Systems Research
- Surgical Outcomes Analysis
- Epidemiology
Background:
- Groin hernia repair surgery (GHRS) is a common elective procedure.
- The COVID-19 pandemic profoundly impacted healthcare systems globally, affecting elective surgeries.
- Understanding these impacts is crucial for health system planning and patient care.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on groin hernia repair surgeries in Romania.
- To compare trends in public and private healthcare sectors during the pandemic.
- To evaluate changes in mean admission periods for GHRS.
Main Methods:
- A nationwide retrospective study of 46,795 GHRS cases from 2019-2021 using DRG database and ICD-10 codes.
- Data collected from 261 hospitals (227 public, 34 private).
- Statistical analysis included Chi-square, F-test, and t-tests with a significance threshold of p < 0.001.
Main Results:
- Overall GHRS decreased by 44.45% in 2020 and 29.72% in 2021 compared to 2019.
- The private sector showed an increase in cases (12.21% and 70.22% in pandemic years).
- Mean admission period was significantly lower in private (2.8 days) vs. public hospitals (5.75 days), with stable short periods in private and decreasing periods in public hospitals during the pandemic.
Conclusions:
- The COVID-19 pandemic led to a substantial reduction in overall GHRS in Romania.
- Romania's private healthcare sector experienced growth in GHRS during the pandemic.
- Private hospitals consistently demonstrated shorter mean admission periods for GHRS compared to public hospitals.
Abstract:
Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.
