1667 variation in acute geriatric medicine activity and outcomes in scotland before, during and after the covid pandemic lockdowns

Abstract Introduction The Scottish Care of Older People (SCoOP) collaborative reports outcomes of acute geriatric medicine admissions across Scottish hospitals. The covid pandemic caused major and variable restructuring of acute services across the country. Their impact on activity and outcomes is unknown. Methods We collated all SMR01/SMR01E hospital episodes from Public Health Scotland from 1st April 2017 to 31st March 2022 where over 50% of the total episode was spent under acute geriatric medicine (code AB) and the diagnosis was not stroke. Activity and outcomes in 19 major hospitals were compared across financial years 2017-19 (before-), 2020/21 (during-) and 2021/22 (after lockdowns). Results Admissions fell by 15% to 36954 in 2020/21 from an average 42566 before recovering to 41971 in 2021/22. Some hospitals were busier than ever in 2020/21 while others saw large reductions in activity. Age, sex and social deprivation profiles differed between hospitals (p<0.001) but remained similar within each hospital at all timepoints. Mortality at 30 days post-admission was 8.5% higher in 2020/21 (17.9% v 16.5% in other years, p<0.001), with 2-fold differences across hospitals. Mean median length of stay (LOS) across hospitals was 11.7 days, compared to 13.6 days in 2017-20, p<0.001. There were up to 17-fold differences in median LOS between hospitals (2-34 days), p<0.001. The impact of the pandemic on LOS within each hospital was variable. Readmission rates at 7 days post-discharge were broadly similar across all years but two-fold differences between hospitals were seen each year (2020/21 4.8%-9.8%, mean 6.8%, p<0.001). Conclusion The impact of the pandemic on the activity and outcomes of individual hospitals was widely disparate, probably reflecting variation in how each hospital service responded to the pandemic. Overall activity and LOS were lower and mortality was higher in 2020/21.