Banca de QUALIFICAÇÃO: Dilson Palhares Ferreira

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : Dilson Palhares Ferreira
DATE: 08/07/2024
TIME: 09:00
LOCAL: Plataforma Virtual WebConferência ACESSO https://conferenciaweb.rnp.br/sala/fabio-ferreira-amorim-2
TITLE:

The impact of the COVID-19 pandemic on births, vaginal deliveries, cesarean sections, maternal mortality, elective surgeries, emergency surgeries, and postoperative mortality in a metropolitan area of Brazil

KEY WORDS:

COVID-19, cesarean section, maternal health services, maternal mortality, elective surgical procedures, Emergency surgical procedures

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: The strain on healthcare systems due to managing COVID-19 led to significant changes in the delivery of healthcare services. Elective and emergency surgeries were canceled or rescheduled, and obstetric and gynecological services were suspended so that the healthcare workforce and resources could be redirected to the population infected with COVID-19. Purpose: To evaluate the impact of the COVID-19 pandemic on birth rates, vaginal deliveries, cesarean sections, elective surgeries, and emergency surgeries. The secondary objective was to compare maternal mortality before and after the pandemic, as well as postoperative mortality in elective and emergency surgeries before and during the pandemic, and to assess the impact of the COVID-19 pandemic on the cancellation of previously scheduled surgeries in a public hospital in the Federal District. Methods: This time-series cohort study includes data of all patients admitted for elective or emergency surgery, as well as all women admitted for childbirth (vaginal delivery or c-section) at the hospitals and maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022. The data were extracted from the Hospital Information System of the Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis, using the CausalImpact R package, evaluated the impact of COVID-19 on surgeries and childbirth, while propensity score matching evaluated the effect on maternal mortality rate using the Easy R (EZR) software. Partial Results: During the study period, there were 174,473 surgeries and 150,617 births. The COVID-19 pandemic led to a reduction in overall surgeries (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective surgeries (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency surgeries (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7). Comparing surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs. 68.8%, P < .001) but no significant change in hospital length of stay (P = .112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2). For childbirth, the overall effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: -24.0−33.4), but there was an increase in c-sections (absolute effect per week: 18.1; 95% CI: 11.9−23.9). After propensity score matching, COVID-19 was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53−6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89 (95% CI: 2.43), suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.

COMMITTEE MEMBERS:
Externa à Instituição - Aline Mizusaki Imoto de Oliveira - ESCS
Externo à Instituição - BRUNO DO VALLE PINHEIRO - UFJF
Presidente - ***.645.631-** - FABIO FERREIRA AMORIM - ESCS
Interno - ***.580.591-** - FRANCISCO DE ASSIS ROCHA NEVES - UNIFESP