ANZ journal of surgery · 2026
Changes in Surgical Admissions and Outcomes During and After the COVID-19 Pandemic: An Exploration of the Australian and New Zealand Audit of Surgical Mortality (ANZASM).
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Shah Dharan A, Procter Nathan E K, Kopunic Helena S, Wichmann Matthias W, Maddern Guy
Аннотация
OBJECTIVES: The effect of COVID-19 lockdown periods on surgical admission patterns in the Australian healthcare system has been relatively unexplored. The impact of these lockdowns was investigated via analysis of a surgical mortality dataset.
SETTING: All cases that had completed the evaluation process by 4 March 2025 (patient death between 1 January 2017 and 31 December 2024, n = 28 685) were included. The ANZASM database captures deaths during surgical admissions, not all surgical admissions. Data from NSW were unavailable at the time of extraction. Cases were grouped into three cohorts, according to date of patient death: pre-COVID (2017-2019), COVID (2020-2021) and post-COVID (2022-2024).
RESULTS: Demographics were consistent across cohorts, with minor differences between pre- and post-COVID for age (p < 0.05), length of stay (p < 0.05) and ASA score (p < 0.001). Differences were observed in admission patterns (p < 0.001). There was a 3.9% decrease in private hospital admissions between pre- and post-COVID (19.1% vs. 15.2%), contrasting with a 4.3% increase in public hospital admissions (79.4% vs. 83.7%). Similarly, there was a decrease in elective procedures between pre- and post-COVID (18.5% vs. 12.9%) and an increase in 'scheduled emergency' procedures (i.e., > 24 h post-admission) (29.7% vs. 33.1%). While there was an overall decrease in postoperative complications post-COVID, there was an increase in the occurrence of anastomotic leaks. There was an increase in palliative care observed between pre- and post-COVID (2.2% vs. 4.1%; p < 0.001).
CONCLUSION: These data indicate lasting shifts in surgical care patterns following the COVID-19 pandemic. The increase in admissions for palliative care under surgery post-COVID could indicate that disease states customarily amenable to surgical intervention had progressed due to delayed diagnosis and COVID-associated shutdowns of elective theatre activity. The increased occurrence of anastomotic leaks post-COVID may reflect skill fatigue, but other potential explanations for this observation also warrant further investigation.
SETTING: All cases that had completed the evaluation process by 4 March 2025 (patient death between 1 January 2017 and 31 December 2024, n = 28 685) were included. The ANZASM database captures deaths during surgical admissions, not all surgical admissions. Data from NSW were unavailable at the time of extraction. Cases were grouped into three cohorts, according to date of patient death: pre-COVID (2017-2019), COVID (2020-2021) and post-COVID (2022-2024).
RESULTS: Demographics were consistent across cohorts, with minor differences between pre- and post-COVID for age (p < 0.05), length of stay (p < 0.05) and ASA score (p < 0.001). Differences were observed in admission patterns (p < 0.001). There was a 3.9% decrease in private hospital admissions between pre- and post-COVID (19.1% vs. 15.2%), contrasting with a 4.3% increase in public hospital admissions (79.4% vs. 83.7%). Similarly, there was a decrease in elective procedures between pre- and post-COVID (18.5% vs. 12.9%) and an increase in 'scheduled emergency' procedures (i.e., > 24 h post-admission) (29.7% vs. 33.1%). While there was an overall decrease in postoperative complications post-COVID, there was an increase in the occurrence of anastomotic leaks. There was an increase in palliative care observed between pre- and post-COVID (2.2% vs. 4.1%; p < 0.001).
CONCLUSION: These data indicate lasting shifts in surgical care patterns following the COVID-19 pandemic. The increase in admissions for palliative care under surgery post-COVID could indicate that disease states customarily amenable to surgical intervention had progressed due to delayed diagnosis and COVID-associated shutdowns of elective theatre activity. The increased occurrence of anastomotic leaks post-COVID may reflect skill fatigue, but other potential explanations for this observation also warrant further investigation.