Surgical Care in Specialist Ophthalmology Departments: Structure and Impact of the COVID-19 Pandemic.

BACKGROUND: Specialist ophthalmology departments contribute to the surgical care of German patients. Outpatient and inpatient surgeries were restricted during the COVID-19 pandemic and led to a sharp decline in the number of cases in ophthalmological care. The aim of this analysis was to improve the understanding of the logistic structures of medical facilities as well as the effects of the pandemic. MATERIAL AND METHOD: Based on reported process data, a sample of the specialist ophthalmological departments were examined based on operation and procedure codes (OPS) and data submitted between 01.01.2017 and 31.05.2021 according to the benchmarking programmes of the Professional Association of German Anaesthetists (BDA), the Professional Association of German Surgeons (BDC), and the Association for Operating Theatre Management (VOPM). RESULTS: Eighteen ophthalmology departments from Germany were analysed. After the decline in the number of cases (by temporarily up to 48%) during the first wave of the pandemic, the case numbers of all interventions assessed as nonurgent continued to be reduced. While intravitreal injections hardly decreased during the first wave (- 16%), significant drops in the coverage of cataract surgery (- 79%), vitrectomies (- 35%), glaucoma surgery (- 59%), strabismus surgery (- 95%), and eyelid surgery (- 52%) were found. One exception was intravitreal injection, which stabilised at a lower level early on during the pandemic. Overall, the number of cases during the later phases of the pandemic were significantly reduced below the level of previous years, despite the maintenance of emergency care. The underuse was variable for different interventions. CONCLUSION: In addition to self-reported figures, the analysed process data demonstrates the effect that various factors had on elective as well as urgent operations within hospital care during the pandemic. Despite partial stabilisation of some services, a relevant supply gap for outpatient and inpatient interventions was identified, with corresponding effects on the eye health of the population, while compensation or performance enhancement have not taken place to date. Facing the growing preload and the demographic development, future structures must therefore allow for an increase in the performance of specialist ophthalmological departments.

[The growing endangerment of specialists in private practice--opening up access to hospital outpatient clinics from the medical specialists' point of view]. / Gefährdung des Facharztes in der freien Praxis--Institutionelle Offnung der Krankenhausambulanzen aus fachärztlicher Sicht.

The legislator is increasingly disadvantaging medical specialists in private practice by promoting hospital-based ambulatory treatment. It should not be ignored, though, that the office-based specialist covers a range of services which has so far not been provided by hospitals, which means that hospitals will have to cope with an additional demand. In the past, hospitals have not exhausted their options either. For instance, only 5% of all ambulatory surgical interventions are performed in hospitals. Apart from institutionally opening up access of hospitals to ambulatory treatment the legislator has provided the hospitals with further advantages and clearly created distorted competition by introducing the concepts of integrated care and ambulatory healthcare centres. The advantages of the office-based specialists' higher flexibility and management competence will be lost. Ambulatory care will be placed in settings producing the highest costs. A much more reasonable alternative, namely the development of specific models of co-operation will be proposed in the following text.