Impact of the First Wave of the COVID-19 Pandemic on the Delivery of Health Care and on Excess Mortality in a Tertiary University Hospital

Background: We aimed to evaluate changes in number, type and severity of diagnoses contributing to hospitalizations and in-hospital and overall mortality among non-COVID patients during the first wave of the COVID-19 pandemic in one of the largest hospitals in Spain.Methods: Observational, descriptive study, including all patients admitted to the VRUH (Virgen del Rocio University Hospital, a 1500-bed tertiary-care university hospital in Seville, Spain), between February 27 and June 7, 2020 (“sub-period-1”, corresponding to the first pandemic wave in Seville) compared with the same period of time in years 2017 to 2019. A similar analysis was also performed between March 17 and April 20, 2020 (“sub-period-2”, corresponding to the excess mortality in Andalucía), versus same period in 2017-2019.Findings: During the sub-period-1, 10·271 admissions without COVID and 323 with COVID-19 were registered in 2020 (annual admissions in 2017-2019 = 14,037±242 [p<0.001 versus 2020]). In 2020, versus 2017-19, there was an excess of in-hospital non-COVID mortality of 25·7% (p<0·001) and a significant increase (p<0·001) of the overall mortality rate in the VRUH health area of 11·2​​ per 100,000 inhabitants (p<0·001). In the sub-period-2, 2·900 admissions without COVID were registered in 2020, with an excess of in-hospital non-COVID mortality of 58·7% (p<0·001). Hospitalization in 2020 was an independent risk factor for mortality during sub-period-2. Among patients hospitalised in 2020, versus 2017-19, there were a significant increase in the mean age of patients, the proportion of men, the number of urgent admissions, longer stays and a greater severity of these patients.Interpretation: The impact of the first wave of the pandemic on non-COVID patients in a large hospital was characterised by a sharp decrease in non-COVID hospitalizations and changes in the spectrum of patients admitted with an increase in their age, length of stay, severity of their condition and in-hospital mortality.Funding: AJV-V acknowledges support from the Programa de Ayudas Beatriz Galindofrom the Ministry of Universities, Government of Spain, and University of Seville, Spain.Declaration of Interest: AJV-V reports participation in research grants to Imperial College London, United Kingdom, from Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron, outside the submitted work; and personal fees for consulting from Bayer and Regeneron and honoraria for lectures from \ Amgen, Mylan, Akcea and Ferrer, all outside the submitted work. All other authors declare no competing interests. Ethical Approval: The study protocol was approved by the Andalusian Biomedical Research Ethics Committee, VRUH, Seville, Spain.