Predicting endoscopic activity recovery in England after COVID-19: a national analysis.
Predicting endoscopic activity recovery in England after COVID-19: a national analysis.
复制标题
DOI：
10.1016/s2468-1253(21)00058-3
复制
发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Lovat LB
中科院分区：
文献类型：
--
作者：
Ho KMA;Banerjee A;Lawler M;Rutter MD;Lovat LB
COVID-19大流行导致胃肠道内窥镜检查大幅减少，造成程序积压。我们的目标是量化英格兰全国的积压，并评估各种干预措施如何减轻积压。我们对英国国民健康服务（NHS）的每月诊断等待时间和活动数据集中的英国国民健康服务（NHS）信托基金的结肠镜检查、乙状结肠镜检查和胃镜检查数据进行了全国性分析。如果月度数据不完整，则排除信托。为估计潜在积压，我们根据疫情前的历史趋势，使用线性逻辑回归预测实际进行的程序与预期程序之间的累积差额。然后，我们在三种情况下进一步估计了积压的变化：恢复到设定的能力水平，范围从90%到130%;活动进一步中断（例如，第二次大流行波）;或引入粪便免疫化学检测（FIT）分流。我们纳入了2018年1月1日至2020年10月31日来自125个NHS信托的数据。2020年4月进行了10476例内窥镜检查，占2019年4月完成的内窥镜检查的9.5%（n= 110584），然后到2020年10月恢复到105716例（占2019年10月完成的84.5%[n= 125072]）。按照目前的轨迹恢复到100%的产能，预计积压量将达到162735辆（95% CI 143 775-181 695）结肠镜检查，119 025（107 398-130 651）次乙状结肠镜检查，以及2021年1月的194 087次（172 564-215 611）次胃镜检查。将产能提高到130%仍需要到2022年6月才能消除积压。再中断2个月将增加额外的15.4%，中断4个月将增加额外的43.8%，中断6个月将增加额外的82.5%。FIT对血红蛋白超过10 μg/g的病例进行分类，将使结肠镜检查转诊减少到正常水平的75%左右，积压的病例将在2022年初清除。我们的工作突出了疫情对全国内镜服务的影响。即使采取缓解措施，消除与流行病有关的积压工作也可能需要一年以上的时间。关键利益相关者（即个人NHS信托基金、临床调试组、英国胃肠病学会和NHS英格兰）需要采取紧急行动，以解决积压问题并防止患者管理延迟。Wellcome/EPSRC介入和外科科学中心（韦斯），伦敦大学学院，国家健康研究所，伦敦大学学院医院生物医学研究中心，以及DATA-CAN，英国健康数据研究。
The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775–181 695) colonoscopies, 119 025 (107 398–130 651) flexible sigmoidoscopies, and 194 087 (172 564–215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 μg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.