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Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption

Author

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  • Noémie Malléjac

    (UR - Université de Rennes, EHESP - École des Hautes Études en Santé Publique [EHESP], ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP], RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Zeynep Or

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LIRAES (URP_ 4470) - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UPCité - Université Paris Cité)

Abstract

The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated. Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.

Suggested Citation

  • Noémie Malléjac & Zeynep Or, 2025. "Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption," Post-Print hal-05018466, HAL.
    • Handle: RePEc:hal:journl:hal-05018466
    DOI: 10.1016/j.healthpol.2025.105309
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