Patel B, Murphy RE, Karanth S, Shiffaraw S, Peters, Jr RM, Hohmann SF, Greenberg RS. Surge in incidence and coronavirus disease 2019 hospital risk of death, United States, September 2020 to March 2021. Open Forum Infect Dis. 2022 Oct;9(10). doi: 10.1093/ofid/ofac424

BACKGROUND Studies of the early months of the COVID-19 pandemic indicate that patient outcomes may be adversely affected by surges. But the impact on in-hospital mortality during the largest surge to date, September 2020-March 2021, has not been studied. This study aimed to determine if in-hospital mortality was impacted by the community surge of COVID-19.

METHODS: A retrospective cohort study of 416,962 adult COVID-19 patients admitted immediately before or during the surge at 229 U.S. academic and 432 community hospitals in the Vizient Clinical Database. The odds ratios of death among hospitalized patients during each phase of the surge was compared with the corresponding odds prior to the surge and adjusted for demographic, comorbidity, hospital characteristic, length of stay and complication variables

RESULTS: The unadjusted proportion of deaths among discharged patients was 9% in both the pre-surge and rising surge stages but rose to 12% during both the peak and declining surge intervals. With the pre-surge phase defined as the referent, the risk-adjusted odds ratios (aORs) for the surge periods were rising, 1.14 (1.10-1.19), peak 1.37 (1.32-1.43), and declining, 1.30 (1.25-1.35). The surge rise in-hospital mortality was present in seven of nine geographic divisions and greater for community hospitals than for academic centers.

CONCLUSIONS: These data support public policies aimed at containing pandemic surges and supporting health care delivery during surges.