Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2023; 13(5): 446-455
Published online Dec 20, 2023. doi: 10.5662/wjm.v13.i5.446
Impact of COVID-19 lockdown on hospital admissions for epistaxis in Germany
Adrian Hoenle, Martin Wagner, Stephan Lorenz, Helmut Steinhart
Adrian Hoenle, Martin Wagner, Helmut Steinhart, Department of Ear, Nose and Throat, Head and Neck Surgery, Marienhospital Stuttgart, Stuttgart 70199, Germany
Stephan Lorenz, Department of Emergency Medicine, Katharinenhospital Stuttgart, Stuttgart 70174, Germany
Author contributions: Hoenle A designed the study, collected and analyzed the data, and wrote and edited the manuscript; Wagner M and Lorenz S collected data for the manuscript; Steinhart H assisted in study design and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethikkommission Marienhospital Stuttgart Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous secondary clinical data which is publicly available.
Conflict-of-interest statement: All the authors report no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Adrian Hoenle, BSc, MD, Doctor, Surgeon, Department of Ear, Nose and Throat, Head and Neck Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany, Stuttgart 70199, Germany.
Received: June 26, 2023
Peer-review started: June 26, 2023
First decision: August 24, 2023
Revised: August 30, 2023
Accepted: September 28, 2023
Article in press: September 28, 2023
Published online: December 20, 2023
Research background

The COVID-19 pandemic has had a profound impact on global healthcare systems, leading many nations to enforce lockdowns that restrict movement and social interactions in an effort to curb virus transmission. Although effective against COVID-19, these measures have inadvertently affected healthcare delivery and hospital admissions. Numerous studies have noted a decline in hospital admissions during the lockdown, attributed to factors such as postponed elective surgeries, decreased Emergency Room visits, and lifestyle-related illness reductions. Despite the apparent benefits of reduced admissions, apprehensions arise over potential long-term health implications due to delayed diagnoses and treatments for non-COVID-19 conditions.

Research motivation

Concerns have arisen due to reports of reduced hospital admissions during the COVID-19 lockdown, suggesting potential delays or omissions in diagnosing and treating non-COVID-19-related illnesses. The decrease in hospital visits during this period has sparked worries about the impact on timely medical interventions. The lockdown's effect on hospital admissions has prompted discussions regarding possible disruptions to the identification and management of non-COVID-19-related medical conditions.

Research objectives

To examine how the COVID-19 pandemic-induced lockdown and its conclusion affected hospital admissions among patients with epistaxis in Germany.

Research methods

Utilizing quasi-anonymous open-access data from Germany's Institute for the Hospital Remuneration System, this retrospective observational study analyzed hospital admissions for epistaxis, considering patient age and gender. The study covered February 1 to June 8 from 2019 to 2022, segmented into six-week periods, with a distinct lockdown group from March 15 to April 26, 2020. Statistical analysis employed Interrupted Time Series and AutoRegressive Integrated Moving Average models, presenting deviations from predicted values. Ethical approval was not necessary due to the absence of identifiable patient data, aligned with ethical guidelines.

Research results

In total, 26183 inpatient cases were analyzed, with a male-to-female ratio of 1.51. The 40-79-year-old group (n = 15145; 58%) had the most cases, followed by those over 80 years (n = 8526; 33%), and the smallest group was aged up to 39 years (n = 2512; 9%). Weekly admissions peaked in 2019 across age and gender groups, while the 2020 lockdown period saw the lowest weekly case numbers for those under 39 years (P < 0.001). In the age group of 40-79 years, 2019 had the highest case numbers (P < 0.001), remaining constant in subsequent years; those over 80 years showed consistent weekly case numbers. Fragmented into 12 time periods, weekly epistaxis cases significantly differed during the restriction (P < 0.001). There was a 22% decrease in cases during the lockdown (P < 0.05), followed by a slight increase of 0.3%, particularly affecting middle-aged males. Lockdown caused a notable 29% decrease in female cases (P < 0.01) and 21% in males, with an 11% post-lockdown increase in females and 2% decrease in males. The male-to-female ratio remained stable. Lockdown led to a significant 51% decrease in young patients (0-39 years, P < 0.001) and a subsequent 50% increase (P < 0.01), while the 40-79 age group had a 22% decrease (P < 0.01) and the oldest group remained constant. These trends were consistent with ITS results, showcasing the impact on different age groups.

Research conclusions

Our study demonstrated that the pandemic-induced lockdown led to a direct decrease in hospitalizations, particularly among young patients with epistaxis. This was followed by a rapid increase after the lockdown was ended. Possible factors contributing to this trend include COVID-19-related fears, unintended consequences of healthcare recommendations, or stay-at-home orders – findings that align with previous research. Notably, older patients were not similarly affected, highlighting the importance of addressing epistaxis symptoms, even in the context of potential COVID-19 exposure. These results emphasize the significant impact of a nationwide intervention like the COVID-19 lockdown on hospital admissions in specific demographic groups.

Research perspectives

Further and more comprehensive research based on larger datasets is necessary to obtain insights into lockdown-induced changes in hospital admissions for other diagnoses as well.