Wellcome Open Research (Nov 2021)

Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India [version 2; peer review: 2 approved]

  • Bharath Kumar Tirupakuzhi Vijayaraghavan,
  • Abi Beane,
  • Augustian James,
  • Neill KJ Adhikari,
  • Dedeepiya Devaprasad,
  • Rashan Haniffa,
  • Rohit Aravindakshan Kooloth,
  • Robert Fowler,
  • Chamira Kodippily,
  • Rajyabardhan Pattnaik,
  • Vrindha Pari,
  • Devachandran Jayakumar,
  • Aasiyah Rashan,
  • Rakesh Laxmappa,
  • Ashwin Mani,
  • Kishore Mangal,
  • Sristi Patodia,
  • Meghena Mathew,
  • Dilanthi Priyadarshini,
  • Ebenezer Rabindrarajan,
  • Mathew Pulicken,
  • Kavita Ramesh,
  • Pratheema Ramachandran,
  • Usha Rani,
  • Nagarajan Ramakrishnan,
  • Ananth Ramaiyan,
  • Lakshmi Ranganathan,
  • Jaganathan Selva,
  • Raymond Dominic Savio,
  • Swagata Tripathy,
  • Ramesh Venkataraman,
  • Ishara Udayanga

Journal volume & issue
Vol. 6

Abstract

Read online

Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 st October 2019 and 27 th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.

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