Dramatic Drop in US Hospital Admissions Occurred in Early Pandemic Months

Admissions at US acute care hospitals fell dramatically for all acute care services during the early COVID-19 pandemic period, according to study results published in the Journal of Hospital Medicine.

“Although declines in April 2020 were greatest in same-day surgery admissions (−73.3% when compared to the number of same-day surgery admissions in April 2019), they rebounded to prepandemic level by September,” wrote researchers from the Centers for Disease Control and Prevention. “Such a degree of return was not observed in other settings.”

The study included electronic health record data for more than 700 general hospitals in the United States. Researchers analyzed adult and pediatric admissions to the acute care hospitals between January 2019 and December 2020 in four service areas: inpatient, observation, emergency department, and same-day surgery.

According to the study, hospitalizations dropped by 50% and same-day surgeries by 73.3% in April 2020. For the year, same-day surgery admissions were down 13.8%, observation admissions decreased 20%, and emergency department admissions fell 22% from the 2019 baseline. 

The largest declines in emergency department (−51.2%), observation (−40.6%), and same-day surgery (−27.4%) admissions in the early pandemic period were among patients younger than 18. The largest decline in inpatient admissions (−13.7%) was among patients 65 and older, according to the analysis.

By disease category, the only increase was in infectious diseases admissions, which rose 52% from 499,641 in 2019 to 758,752 admissions in 2020.

Inpatient case mix index, length of stay, and non-COVID death rate were higher in all months in 2020 compared with respective months in 2019, the study showed.

“The complexity and severity of illness among hospitalized patients were higher during the pandemic months compared to prepandemic months, as evidenced by an increased death rate among non-COVID-19 patients,” researchers wrote. “This indicates that while there were fewer admissions, health care providers dealt not only with surges in COVID-19 patients but also sicker non-COVID-19 patients. Furthermore, as the hospital burden of COVID-19 increased during the early pandemic period, there was a parallel increase in mortality among non-COVID patients and overall patient severity.”

Reference:
Kazakova SV, Baggs J, Parra G, et al. Declines in the utilization of hospital-based care during COVID-19 pandemic. J Hosp Med. Published online August 29, 2022. doi:10.1002/jhm.12955