Impact of the COVID-19 Pandemic on Frequency of Surgeries in Germany Based on Hospital Data

OBJECTIVES: During the COVID-19 pandemic, German hospitals were urged to postpone schedulable surgeries to provide available capacity for acute treatment. The aim of the study was to assess the impact of the pandemic on frequency of inpatient surgeries in Germany.

METHODS: This retrospective data analysis was based on German hospital data from the Institute for the Hospital Remuneration System (InEK) of the years 2019 to 2022. Inpatient surgeries were identified by OPS codes. The frequency and distribution of surgeries in 2020 to 2022 were compared to the baseline year 2019 and stratified by COVID-19 waves (wild type, alpha, delta, omicron).

RESULTS: The number of inpatient surgeries decreased from 17,266,832 (2019) to 15,854,447 (2020) and slightly increased to 15,872,909 (2021) and 15,943,982 (2022). Compared to the pre-COVID-19-year 2019, the largest declines between 2020 and 2022 were observed in surgeries on ears (2020: -22.9%, 2021: -29.0%, 2022: ‑20.0%), nose and paranasal sinuses (2020: -20.3%, 2021: -22.2%, 2022: -25.6%), and oral cavity and face (2020: -22.0%, 2021: -29.7%, 2022: -22.6%). Nevertheless, steady declines were recorded in all areas except obstetric surgeries (2020: +0.7%, 2021: +4.0%, 2022: -4.1%) with the overall frequency of surgeries remaining below pre-COVID-19 levels in 2022.

Comparing frequency of surgeries during each COVID-19 wave between 2020 and 2022 to baseline, the greatest decrease was observed during the alpha wave across all areas. Again, largest declines were observed in surgeries on ears (-78.8%), followed by oral cavity and face (-77.9%), and nose and paranasal sinuses (-74.2%). During omicron wave, the level of surgeries recovered slowly with decreases of -19.7%, -22.4%, and -25.4%, respectively.

CONCLUSIONS: This study found that consequences of the COVID-19 pandemic were associated with considerably lower frequency of elective surgeries in Germany, with greatest impact on ear, nose, and throat surgeries. So far, no catch-up effects for elective surgeries were observed.