The Geneva Canton organized the health crisis of the COVID-19 epidemic around the care of COVID patients at the University Hospital (HUG), by moving the care of non-COVID patients to private hospitals of the canton. The COVID epidemic appears to have been associated with a decrease in consultations and care for non-COVID patients. An excess of morbidity and mortality (non-COVID) would be possible during or after the epidemic in connection with this "under-medicalization" of non-COVID patients. The aim of this study is to measure and analyze the impact on the morbidity and mortality of inpatients during and after the COVID-19 epidemic in the adult inpatient wards of HUG and township hospitals / clinics.
The analysis of the various results will be carried out on all HUGs and on the various hospitals / clinics in the canton. A survival analysis for the outcome of death or rehospitalization will be performed, with a comparison according to each period. After epidemy evolution, finally, the outcomes will be compared between periods pre-COVID (from 01 march 2019 to 28 february 2020) versus per-COVID (01 march 2020 to 28 february 2022), and versus post-COVID (01 march 2022 to 28 february 2023). And comparaison would be performed between periods during the wave (per-wave) versus periods inter-wave. A description will be made in number (%) for numerical data and in median (IQR) for quantitative data. Univariate comparisons between the different periods will be carried out by statistical tests, parametric or not, adapted according to the data (Chi2 or Fisher's test for qualitative data, Student's test or Mann-Whitney-Wilcoxon for quantitative data). Statistical significance will be retained in the event of p \<0.05. Multivariate analysis will be performed by logistic regression for the main outcome and by cox model for survival analysis. Different variables will be included in the models, including data on gender, age and comorbidity, as well as any variable having a difference with p \<0.2 in univariate analysis. Secondary analyzes will be carried out by pathology (as the main diagnosis) according to the specific results defined for each situation. In retrospective analysis, these specific data will be relatively limited on the HUG area of full analysis brings together around total of 240,000 hospital stays. The main outcome data will be complete with no missing data. On the other hand, since this is retrospective data, it is possible that some important variables are missing. In this case, other patient data with missing data will not be included in the multivariate analyzes. In the event of missing data greater than 10%, a second sensitivity analysis may be performed after replacing the missing data with a multiple imputation method.
Study Type
OBSERVATIONAL
Enrollment
240,000
Geneva University Hospital
Geneva, Canton of Geneva, Switzerland
Intra-hospital mortality
death during hospitalization of each patient
Time frame: Assessed at the discharge date, up to 3 months after admission
composite outcome (worsening during hospitalization)
intra-hospital mortality and / or transfer to intensive care and / or transfer to intermediate care during hospitalization
Time frame: At the discharge date of hospitalization, up to 3 months after admission
Pathologies leading to hospitalization
Primary and secondary diagnosis during hospitalization (CIM10 codes)
Time frame: At the discharge date of hospitalization, up to 3 months after admission
overall mortality at 3 months (90 days)
intra or extra hospital mortality : death occuring during hospitalization or after
Time frame: within the 3 months after the admission date
Potentially avoidable readmission rate
Potentially avoidable readmission according to SQLape algorithm (http://www.sqlape.com/READMISSIONS.htm)
Time frame: During the 30 days after the patient's discharge
mortality rate by pathology at 3 months
mortality for each top 10 of pathologies (intra or extra hospital mortality for each pathology)
Time frame: within the 3 months after the admission date
length of stay
Hospital length of stay (Time between admission date and discharge date)
Time frame: At the discharge date of hospitalization, up to 3 months after admission
rate of transfer to intermediate or intensive care
Number of patients with transfer to intensive or intermediate care during hospitalization
Time frame: At the discharge date, up to 3 months after admission
rate of transfer to rehabilitation care
Number of patients with rehabilitation transfer during hospitalization
Time frame: At the discharge date of acute care, up to 3 months after admission
specific gravity outcomes for patients with pneumonia : CURB 65 scale (Confusion, Urea, Respiratory rate, Blood pressure, Age [>65])
CURB65 scale: min-max 0 to 5 points \[5 points : worse outcome\]
Time frame: At the acute care admission
specific gravity outcomes for patients with cardiac Failure : KILLIP class
KILLIP class (class 1 to 4) \[class 4 : worse outcome\]. The KILLIP classification is a system used in individuals with an acute myocardial infarction (heart attack), taking into account physical examination and the development of heart failure in order to predict and stratify their risk of mortality.
Time frame: At the acute care admission
specific gravity outcomes for patients with cardiac Failure : Weight variation
Weight variation : variation of weight at the admission compared to the basis weight
Time frame: At the acute care admission
specific gravity outcomes for patients with cardiac Failure or lung disease
FIO2 (% O2 prescribed): Fraction of inspired oxygen
Time frame: At the acute care admission
Leukocytes serum level
Giga / litre
Time frame: At the acute care admission
Polynuclear neutrophils serum level
Giga / litre
Time frame: At the acute care admission
Lymphocytes serum level
Giga / litre
Time frame: At the acute care admission
Hemoglobin serum level
gram/litre
Time frame: At the acute care admission
Thrombocytes serum level
Giga / litre
Time frame: At the acute care admission
Quick serum level
in %
Time frame: At the acute care admission
INR (International Normalized Ratio)
No unit
Time frame: At the acute care admission
fibrinogen serum level
gram/litre
Time frame: At the acute care admission
PTT serum level (partial Thromboplastin time)
in second
Time frame: At the acute care admission
D-Dimers serum level
ng / ml
Time frame: At the acute care admission
glucose serum level
mmol / litre
Time frame: At the acute care admission
glycated hemoglobin serum level (HbA1C)
in %
Time frame: At the acute care admission
C-reactive protein serum level (CRP)
mg / litre
Time frame: At the acute care admission
sodium serum level
mmol / l
Time frame: At the acute care admission
potassium serum level
mmol / l
Time frame: At the acute care admission
chlorides serum level
mmol / l
Time frame: At the acute care admission
calculated osmolality serum level
mOsm / kg
Time frame: At the acute care admission
Phosphates serum level
mmol / l
Time frame: At the acute care admission
corrected calcium serum level
mmol / l
Time frame: At the acute care admission
urea serum level
mmol / l
Time frame: At the acute care admission
creatinine serum level
µmol / l
Time frame: At the acute care admission
eGFR (CKD-EPI) serum level
ml / min / 1.73m2
Time frame: At the acute care admission
albumin serum level
g / l
Time frame: At the acute care admission
prealbumin serum level
mg / l
Time frame: At the acute care admission
cyanocobalamin serum level
pmol / l
Time frame: At the acute care admission
folate serum level
nmol / l
Time frame: At the acute care admission
25-hydroxy vitamin D (D2 + D3) serum level
nmol / l
Time frame: At the acute care admission
proBNP (Brain Natriuretic Peptid) serum level
ng / l
Time frame: At the acute care admission
Ultra sensitive Troponin T serum level
ng / l
Time frame: At the acute care admission
ASAT (aspartate transaminase) serum level
U / l
Time frame: At the acute care admission
ALAT (alanine aminotransferase) serum level
U / l
Time frame: At the acute care admission
Alkaline phosphatases serum level
U / l
Time frame: At the acute care admission
Gamma glutamyl transpeptidase. serum level
U / l
Time frame: At the acute care admission
Total bilirubin serum level
µmol / l
Time frame: At the acute care admission
ferritin serum level
µg / l
Time frame: At the acute care admission
TSH serum level
mU / l
Time frame: At the acute care admission
Arterial pH
No unit
Time frame: At the acute care admission
Arterial pCO2 (carbon dioxide partial pressure)
kPa
Time frame: At the acute care admission
Arterial pO2 (oxygen partial pressure)
kPa
Time frame: At the acute care admission
Arterial lactate
mmol / l
Time frame: At the acute care admission
Arterial HCO3 (bicarbonate)
mmol / l
Time frame: At the acute care admission
protein serum level
g / l
Time frame: At the acute care admission
Arterial pressure
Arterial pression (min-max), in mmHg
Time frame: At the acute care admission
cardiac rates
Bat/mn
Time frame: At the acute care admission
respiratory rates
/mn
Time frame: At the acute care admission
temperature
Celsius degrees
Time frame: At the acute care admission
oxygen saturation
Percutaneous oxygen saturation (in %)
Time frame: At the acute care admission
peak flow
L/mn
Time frame: At the acute care admission
specific scales : VAS of pain
Visual analog Pain scale (min-max : 1 to 10 \[worse outcome\])
Time frame: At the acute care admission
specific scales : FIM
Functional Independence Measure (min-max : 18 \[worse outcome\]) to 126)
Time frame: At the acute care admission
specific scales : SOFA score
Sequential Organ Failure Assessment Score (min-max : 0 to 24 \[worse outcome\])
Time frame: At the acute care admission
specific scales : MNA
Mini Nutritional Assessment (min-max : 0 \[worse outcome\] to 14)
Time frame: At the acute care admission
specific scales : NRS
Nutrition Risk Screening (min-max : 0 to 12 \[worse outcome\])
Time frame: At the acute care admission
serum or urine positive bacteriologic sample
number of positive hemoculture or urinary cultures
Time frame: At the acute care admission or during hospitalization
Patient questionnaire
Questionnaire asking each patient if they had difficulty seeing a doctor before their hospitalization and if they delayed their hospitalization due to the COVID-19 crisis.
Time frame: At the discharge date of hospitalization, up to 3 months after admission
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