It is now clear that Covid has been like a tsunami for hospitals. But reading the official numbers lined up on the effects of the pandemic on health, we can better understand the dimension of the wave that has overwhelmed the other treatments to be guaranteed to Italians: if in 2021 there was a mini recovery compared to 2020 with 500 thousand hospitalizations in more if you add up the hospitalizations, it turns out that 2.9 million hospitalizations have been lost in two years of the pandemic.
Last year, however, recovery was reported in all hospital wards, but the balance remains negative almost everywhere. Among the few positive signs is the resumption of some oncological operations such as those for breast cancer. “Making up the delays due to the pandemic emergency is one of my priorities,” assured the Minister of Health Horace Schillaci.
The impact of the pandemic on hospitalizations
The numbers come out of the latest National Outcomes Plan just published by Agenas (the National Agency for Regional Health Services) on a mandate from the ministry. The data refer to the care activity carried out in 2021 by 1,377 public and private hospitals, and to that relating to the period 2015-2021 for the reconstruction of temporal trends. Last year, as mentioned, there was an increase in hospitalizations compared to 2020 (+501,158), but with numbers still far from pre-pandemic levels: in fact, there were 1 million and 200 thousand fewer hospitalizations than in 2019, which add up to 1 million and 700 thousand hospitalizations not carried out in 2020. “The results – explains Agenas – demonstrate on average the stability of the hospital care system, in particular as regards the timeliness of access to urgent care and the resumption of some oncological interventions such as those for breast cancer. However, the old evil of Italian healthcare persists, namely the “great heterogeneity of outcomes” both within the Regions and between Regions, in particular between North and South
Half hospitals below standards for timely treatment
According to the new report, the number of urgent hospitalizations was lower than the expected value based on what happened before the pandemic: in particular -10% for acute myocardial infarction (about 11,300 fewer hospitalizations) and -6% for fracture of femur (about 5,800 fewer hospitalizations). Still negative are the performances on the timeliness of access to urgent treatments which remains below the standards of care in over half of the Italian hospitals: the proportion of patients undergoing coronary angioplasty within 90 minutes of admission was on average 50.6% , while the proportion of older adults with hip fracture operated on within 48 hours averaged 48.6%. In both cases, the threshold established by hospital standards is 60%. Mortality 30 days after a heart attack episode was however slightly reduced in 2021 compared to 2020 (7.7% vs. 8.4%) getting closer to the values of 2019 (7.3%). Mortality 30 days after hospitalization for hip fracture has instead remained stable compared to 2020 (6.4% vs. 6.6%), but is still higher than in the pre-pandemic period (5.1% in 2019).
Partial recovery for planned hospitalizations
As regards planned hospitalizations, a partial recovery was recorded in 2021 compared to 2020, but a deviation from the previous levels remains (-16% compared to 2019). In particular, for isolated coronary artery bypass surgery, there was a reduction of 1,900 hospitalizations compared to expectations; in the two-year period 2020-2021, the overall deviation from the trend can be estimated at around 5,000 hospitalizations. 2/3 of the operations were performed in structures below the threshold set by the minimum hospital standards (200 operations/year). In the musculoskeletal area, on the other hand, there was a significant recovery in planned activities compared to 2020 (especially in the private sector), with an increase of 18,000 hip replacement operations and 14,000 knee replacement operations. However, there remains a gap compared to pre-pandemic levels: in the two-year period 2020-2021, the overall loss compared to the trend can be estimated at around 27,000 hip replacement operations and 39,000 knee replacement operations.