Groin Hernia Repair during the COVID-19 Pandemic-A Romanian Nationwide Analysis.

Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

In-hospital admissions and deaths in the context of the COVID-19 pandemic, in Romania.

Introduction: The COVID-19 pandemic context led to a relevant burden on essential sectors of society; hospital sector capacity is tested in this period. Methods: A cross-sectional study of admissions in hospitals reporting DRG data for 2018-2020. Trend analysis of admissions and deaths in hospitals was carried out for identifying annual patterns and deviations from the 2010-2020 trend. Data aggregated by year, month, diagnosis, death in hospital. Graph analysis for time and diagnosis comparisons and correlation identifying associations. Results: There is an annual change in admission and death patterns recorded in Romanian hospitals. An important contraction in number of acute hospital admissions was recording during the COVID-19 pandemic; patients' hesitancy to seek healthcare and limited capacity to treat patients other than COVID-19 patients due to legal regulations limiting the admissions number could explain this pattern of admission only for serious condition or emergency surgery. In Romania excess deaths in second half 2020 was generally greater than COVID-19 deaths. Overall, excess mortality between March and December 2020 was more than double than reported COVID-19 deaths. The same mortality pattern persists, but with significant decreases for some diagnoses. Conclusions: The Romanian healthcare system has been challenged due to COVID-19 pandemic, leading to temporary reorganization of hospitals with consequences on all acute care diagnostics and therapeutic pathways. It is a challenge to identify causes of reduced inpatient treatment rates and to provide evidence on hospital activity for understanding future optimal management of patients with COVID-19, but also with other acute and chronic conditions.

Retrospective analysis and time series forecasting with automated machine learning of ascariasis, enterobiasis and cystic echinococcosis in Romania.

The epidemiology of neglected tropical diseases (NTD) is persistently underprioritized, despite NTD being widespread among the poorest populations and in the least developed countries on earth. This situation necessitates thorough and efficient public health intervention. Romania is at the brink of becoming a developed country. However, this South-Eastern European country appears to be a region that is susceptible to an underestimated burden of parasitic diseases despite recent public health reforms. Moreover, there is an evident lack of new epidemiologic data on NTD after Romania's accession to the European Union (EU) in 2007. Using the national ICD-10 dataset for hospitalized patients in Romania, we generated time series datasets for 2008-2018. The objective was to gain deep understanding of the epidemiological distribution of three selected and highly endemic parasitic diseases, namely, ascariasis, enterobiasis and cystic echinococcosis (CE), during this period and forecast their courses for the ensuing two years. Through descriptive and inferential analysis, we observed a decline in case numbers for all three NTD. Several distributional particularities at regional level emerged. Furthermore, we performed predictions using a novel automated time series (AutoTS) machine learning tool and could interestingly show a stable course for these parasitic NTD. Such predictions can help public health officials and medical organizations to implement targeted disease prevention and control. To our knowledge, this is the first study involving a retrospective analysis of ascariasis, enterobiasis and CE on a nationwide scale in Romania. It is also the first to use AutoTS technology for parasitic NTD.

The Use of Minimal Invasive Surgery versus Open Approach in Hospitalized Cases.

Backgtound: The progress in development and application of Minimal Invasive Surgery (MIS) requires clinical and managerial decisions that must be evidence based; the current available scientific evidence for the Romanian medical practice is missing. Our study aims to analyze the use of MIS and open surgery in Romania and the impact of the type of surgery on the hospitalization. Methodology: A cross-sectional study analyzed the activity of the Romanian hospitals reporting primary Diagnostic Related Group (DRG) data at the patient level in the period 2008-2018; all episodes of abdominal and thoracic surgical interventions which may be performed either by MIS or an open approach were extracted from the DRG National database (www.drg.ro). A comparative analysis in terms of the volume of activity and their impact on the hospital average length of stay (ALOS) has been performed. Results: The pattern of use for MIS and open surgery interventions was changed in 2008-2018; MIS procedures doubled while open surgery interventions did not follow the same growth rate; ALOS for the MIS procedures decreased annually at a faster rate as compared to the ALOS for the open surgery and the gap between the two gradually increased in favour of the MIS interventions. The most pronounced shortening of ALOS after MIS procedures has been found for Gallbladder Surgery (by 7.95 days), Gastric Surgery (by 5.64 days) and Incisional Hernia surgery (by 4.33 days). Meanwhile, the reimbursement level for the MIS versus open surgery interventions did not changed over the analyzed period. Conclusions: MIS is significantly reducing the ALOS in Romania with a potential positive influence on the national healthcare budget. However, the pattern of use for MIS interventions is not financial incentives based and calls for in-depth analysis on other factors belonging rather to specific pathology, technology or medical practice (experience in using MIS, endowment, safety, efficacy, surgical approach area etc.) is urgently required.

Health systems and the right to health: an assessment of 194 countries.

60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.