Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy

The hidden toll of the pandemic on nonrespiratory patients

While many empirical studies have focused on the health consequences of COVID-19 for infected individuals, little attention has been given to its consequences for patients with nonrespiratory medical conditions. In this study, we apply machine learning and regression analysis techniques to complete-coverage administrative records of inpatient hospitalizations in Italy in 2012-2021 to investigate how the outbreak has impacted on the treatment of nonrespiratory patients in one of the countries most acutely affected by the pandemic. A comparison of hospital- and population-level excess deaths suggests that 53.7% of COVID-19 deaths occurred outside of hospitals. We interpret this as evidence of limited hospital resources, and we show that a higher number of hospital beds per capita is associated with a greater proportion of in-hospital deaths. We also document a 22.6% decrease in hospitalizations of nonrespiratory patients, more pronounced for patients in less severe conditions, and a conditional decrease of 0.5 days in the average length of stay for nonrespiratory patients. We attribute these changes to fear of infection and hospital resource limitations, and we show that the drop in admissions is more pronounced in areas that were more impacted by COVID-19 and had fewer hospital beds per capita. Our findings suggested that the pandemic's direct impact on infected individuals is just a fraction of the broader health losses in the population.