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During the COVID-19 pandemic, hospitals have reorganised to provide adequate care to a large number of patients. Consequently, non-acute, elective surgeries and diagnostics were postponed. Since May 2020, Dutch hospitals are gradually upscaling non-COVID care. In this unique situation the consequences of postponed diagnostics and surgeries can be studied. The results will help physicians and hospitals in the (nearby) future to make informed decisions in case of a future peak of COVID-19 outbreak, or other comparable crisis situations which may result in temporarily lower capacity for elective surgical care.

The aim of the TRACE II study is to investigate the effect of the COVID-19 pandemic on usual care for elective surgical patients and on patient outcome. The proposed study consists of a retrospective and a prospective part.

Retrospectively, we aim to describe the practice and outcome of all patients between March and June 2020 (high risk surgery during COVID peak). In the prospective part we plan to follow surgical patients from September 2020 onwards. As a control group, we will make use of data from the previous TRACE study: a nationwide interventional study on peri-operative patient outcomes in nine hospitals in the Netherlands between 2016 and 2019. The database contains records of >5400 patients undergoing medium/high-risk surgery before the COVID-19 outbreak, with detailed information on patient characteristics, recovery, complications, mortality, and quality of life. The control group of TRACE (N=~2500) can serve as a control cohort for this proposed follow-up study.

We hypothesize that surgical patients in the new cohort have poorer health conditions prior to surgery and poorer health outcomes post-surgically compared to the control cohort. In addition, we hypothesize that patient pathways changed, e.g. length of intensive care stay.


The results from this study may impact future prioritisation of surgeries, as well as organisation of postoperative care.


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