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Sim CHS, Woo BJ, Liow MHL, Pang HN, Yeo SJ, Tay D, Liu X, Lim JBT, Chen JDY. Postponement of total knee arthroplasties due to pandemic causes significant deterioration on patients' preoperative knee and quality of life scores. J Orthop 2024; 55:114-117. [PMID: 38681830 PMCID: PMC11046234 DOI: 10.1016/j.jor.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Elective surgeries were postponed during the COVID-19 pandemic to alleviate healthcare strains, affecting majority of elective orthopaedic surgeries such as total knee arthroplasties (TKAs). The aim of this study is to evaluate the impact on knee function and quality of life of patients who had their planned TKA postponed due to the pandemic. Methods This is a retrospective analysis of data collected in a tertiary hospital. Patients included were diagnosed with primary knee osteoarthritis and they were initially scheduled for primary TKA between January to April 2020 but surgery was postponed by at least 6 months from the initial operative date. 160 patients were included in this study (53 males and 107 females, mean age 68.0 ± 8.1). Patients were assessed prior to initial surgery date and assessed again, prior to the postponed surgery date. Clinical scores included Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee scores (OKS) and Short-Form 36 Physical and Mental Component Scores. (SF36 PCS and MCS). Paired T-test was performed for parametric data whereas Wilcoxon signed-rank analysis was performed for non-parametric data. Results Comparing initial preoperative versus postponement preoperative scores, the cohort had significantly poorer KSKS (38.4 ± 15.4 and 36.5 ± 15.4, p = 0.034), SF36 PCS (34.3 ± 9.2 and 32.7 ± 8.6, p = 0.02) and OKS (34.9 ± 0.77 and 35.8 ± 8.6, p = 0.02) scores respectively. Conclusion The postponement of elective TKAs has resulted in a significant deterioration of knee scores and physical quality of live scores of patients in a short span of 6 months. Further studies can evaluate if there are repercussions on long term TKAs outcomes. Level of evidence Retrospective study, Level III.
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Affiliation(s)
- Craigven Hao Sheng Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Bo Jun Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Darren Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Xuan Liu
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Jason Beng Teck Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
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Sanchez JG, Jiang WM, Dhodapkar MM, Radford ZJ, Rubin LE, Grauer JN. 90-Day Complication and Readmission Rates for Geriatric Patients With Hip Fracture at Different Time Points From COVID-19 Positivity: A Database Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202409000-00010. [PMID: 39330875 PMCID: PMC11412709 DOI: 10.5435/jaaosglobal-d-24-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Geriatric patients with hip fracture are at risk of having COVID-19 while needing fracture treatment. Understanding the associated risks of variable timing of COVID-19 before surgery may help direct care algorithms. METHODS Geriatric patients with documented hip fracture surgery were identified within the PearlDiver M157 database. Patients with a preoperative COVID-19 diagnosis were classified based on time from diagnosis to surgery: ≤ 1 week, > 1 to ≤ 4 weeks, > 4 to ≤ 7 weeks, > 7 to ≤ 10 weeks, and > 10 to ≤ 13 weeks. The association of COVID-19 diagnoses with 90-day complications was evaluated. RESULTS Overall, 263,771 patients with hip fracture were identified, of which COVID-19 within 13 weeks of surgery was documented for 976. On multivariable analysis, patients with COVID-19 infection within ≤ 1 week preoperatively demonstrated increased rates of minor adverse events (odds ratio (OR) = 1.50), all adverse events (OR = 1.59), sepsis (OR = 1.70), and pneumonia (OR = 2.35) (P ≤ 0.0007 for each). For time points greater than 1 week, there were no differences in complication rates. DISCUSSION Patients with COVID-19 within 1 week of hip fracture surgery demonstrated greater odds of 90-day complications. Reassuringly, patients with COVID-19 diagnoses more than 1 week preoperatively were not associated with increased odds of any assessed complication.
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Affiliation(s)
- Joshua G Sanchez
- From the Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT
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Bric JD, Miley EN, Parvataneni HK, Pulido L, Prieto HA, Gray CF, Deen JT. Outpatient total hip and knee arthroplasty - Patient expectations versus experience. J Orthop 2024; 51:109-115. [PMID: 38371352 PMCID: PMC10867624 DOI: 10.1016/j.jor.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
Aims & objectives With modern advancements in surgical techniques and rapid recovery protocols, incidence of outpatient total joint arthroplasty (TJA) is increasing. Previous literature has historically focused on cost, safety, and clinical outcomes, with few studies investigating patient expectations and experiences. The aim of this study was to survey preoperative patient expectations related to outpatient TJA surgery compared with perioperative perceptions and experience. Materials & methods Prospective study of patients undergoing outpatient total hip or knee arthroplasty at a single Tertiary Academic center. Preoperative and postoperative surveys were administered during routine clinic visits. Results One hundred and six patients completed preoperative surveys; 79 completed postoperative surveys and were included in the final data analysis. Fifty (63.3 %) patients reported being aware of outpatient TJA prior to undergoing the procedure. There was no difference between preoperative anticipated pain control and postoperative perceived pain control (6.64 vs. 6.88, p = 0.77). Most postoperative patients (N = 56, 70.9 %) rated outpatient surgery as "much better" or "better" than expected. Most postoperative patients (N = 68, 86 %) would opt to have outpatient surgery again. Fifty-two (65.8 %) of postoperative patients believed outpatient surgery sped up their postoperative rehabilitation. Conclusion For most patients, the outpatient surgical experience met or exceeded expectations. Nearly 90 % of patients would prefer to have outpatient surgery in the future, further supporting the continued migration of elective arthroplasty away from inpatient sites of care.
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Affiliation(s)
- Justin D. Bric
- The Southeast Permanente Medical Group, Atlanta, GA, USA
| | - Emilie N. Miley
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Luis Pulido
- Florida Orthopedic Institute, Gainesville, FL, USA
| | - Hernan A. Prieto
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
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Cooper GM, Bayram JM, Clement ND. The functional and psychological impact of delayed hip and knee arthroplasty: a systematic review and meta-analysis of 89,996 patients. Sci Rep 2024; 14:8032. [PMID: 38580681 PMCID: PMC10997604 DOI: 10.1038/s41598-024-58050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
This systematic review and meta-analysis aimed to determine the impact of presurgical waiting times on pre-/post-operative joint specific pain and function, health-related quality of life (HRQOL) and perspectives of patients awaiting primary elective total hip (THR) and knee (TKR) replacements. MEDLINE, EMBASE, PUBMED, and CENTRAL databases were searched from inception until 30th January 2023 (CRD42022288128). Secondary literature and unpublished datasets containing paediatric, non-elective, partial, or revision replacement populations were excluded. PRISMA 2020 reporting and GRADE certainty of evidence guidelines were followed. Residual maximum likelihood meta-analysis and linear meta-regression was performed to elucidate the influence of presurgical waiting time. Twenty-six studies were eligible for systematic review and sixteen for meta-analysis, capturing 89,996 patients (60.6% female, mean age 67.4 years) between 2001 and 2022. A significant deterioration in joint function (mean difference (MD):0.0575%; 95% CI 0.0064, 0.1086; p = 0.028(4d.p.); I2 = 73.1%) and HRQOL (MD: 0.05%; 95% CI - 0.0001.0009; p = 0.011(4 d.p.); I2 = 80.6%) was identified per additional day of waiting. Despite qualitative evidence, meta-analysis could not observe a relationship with postoperative outcome data. Patient responses to delayed THR and TKR surgery were unanimously negative. Immediate action should seek to reduce the increased patient anxiety and significant reductions in pre-operative joint functionality and HRQOL associated with prolonged pre-surgical waiting time, whilst mitigating any potential deleterious post-operative effects.
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Affiliation(s)
- G M Cooper
- University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - J M Bayram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
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Ling K, Tsouris N, Nazemi A, Komatsu DE, Wang ED. Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection. JSES Int 2023; 7:2425-2432. [PMID: 37969527 PMCID: PMC10638568 DOI: 10.1016/j.jseint.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background A recent meta-analysis comparing inpatient and outpatient total shoulder arthroplasty (TSA) showed no statistically significant differences in complications, readmissions, revisions, and infections. However, there remains no research on the appropriate patient selection for outpatient TSA surgeries. This retrospective review seeks to aid surgeons in refining a safe patient selection algorithm by evaluating risk factors through a large database analysis of TSA surgeries. Methods Patients who underwent TSA between 2015 and 2020 were identified in the National Surgical Quality Improvement Program database. Patients with a hospital stay of 0 days were designated as outpatient procedures. Multivariate analyses were used to determine risk factors for 30-day readmission following outpatient TSA and whether risk factors remained significant following overnight hospital stay. Results A total of 2431 outpatient TSA patients were identified. The incidence of 30-day readmission was 1.8%. The majority of readmissions were due to pulmonary complications. The clinically significant risk factors for 30-day readmission were chronic steroid use (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.34-9.43; P = .011), chronic obstructive pulmonary disease (COPD) (OR 3.11, 95% CI 1.16-8.34; P = .024), and current smoking status (OR 2.27, 95% CI 1.02-5.03; P = .045). After overnight hospital stay, chronic steroid use and current smoking status were not significant, but COPD remained significant. Conclusion Patients with chronic steroid use, COPD, or current smoking status are at increased risk for 30-day readmission. Inpatient hospital stay appears to benefit patients with chronic steroid use and current smoking status. Patients with COPD should be admitted for inpatient stay postoperatively but may still have high 30-day readmission rates following discharge.
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Affiliation(s)
- Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Nicholas Tsouris
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Alireza Nazemi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
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Sniderman J, Abdeen A. The Impact of the COVID-19 Pandemic on the Practice of Hip and Knee Arthroplasty. JBJS Rev 2023; 11:01874474-202311000-00002. [PMID: 37972217 DOI: 10.2106/jbjs.rvw.23.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
» The COVID-19 global pandemic resulted in unprecedented disruptions in care including massive surgical cancelations, a shift to outpatient surgery, and novel medical risks posed by COVID-19 infection on patients undergoing joint replacement surgery.» Refined patient optimization pathways have facilitated safe, efficient outpatient total joint arthroplasty in patient populations that may not otherwise have been considered eligible.» Rapid innovations emerged to deliver care while minimizing the risk of disease transmission which included the widespread adoption of telemedicine and virtual patient engagement platforms.» The widespread adoption of virtual technology was similarly expanded to resident education and continuing medical activities, which has improved our ability to propagate knowledge and increase access to educational initiatives.» Novel challenges borne of the pandemic include profound personnel shortages and supply chain disruptions that continue to plague efficiencies and quality of care in arthroplasty and require creative, sustainable solutions.
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Powell D, Markel D, Chubb H, Muscatelli S, Hughes R, Hallstrom B, Frisch N. The Differential Effect of COVID on Total Joint Arthroplasty Between Hospital and Ambulatory Surgery Centers/Hospital Outpatient Departments: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis. Arthroplast Today 2023; 23:101189. [PMID: 37731594 PMCID: PMC10507191 DOI: 10.1016/j.artd.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Coronavirus disease (COVID) created unprecedented challenges, especially for high-volume elective subspecialties like total joint arthroplasty. Limited inpatient capacity and resource conservation led to new outpatient selection criteria and site of service changes. As a Michigan Arthroplasty Registry Quality Collaborative Initiative quality project, demographic changes, complications, and differential effects on inpatient vs outpatient centers pre- and post-COVID were analyzed. Methods The registry identified all total joint arthroplasty at hospitals and ASCs/HOPDs between 07/2019-12/2019 and 07/2020-12/2020. These intervals represented pre-COVID and post-COVID elective surgery shutdowns. Case volumes, demographics, and 90-day complications were compared. Results Comparing 2020 to 2019, hospital volumes decreased (-9% total hip arthroplasty [THA], -17% total knee arthroplasty [TKA]), and ambulatory surgery center (ASC)/hospital outpatient department (HOPD) increased (+84% THA, +125% TKA). Entering 2020, ASC/HOPD patients were older (P = .0031, P < .0001: THA, TKA), had more American Society of Anesthesiologists score 3-4 (P = .0105, P = .0021), fewer attended joint class (P < .0001, P < .0001), and more hips were women (P = .023). Hospital patients had higher preoperative pain scores (P = .0117, P < .0001; THA, TKA), less joint education attendance (P < .0001, P < .0001), younger TKAs (P = .0169), and more American Society of Anesthesiologists score 3-4 (0.0009). After propensity matching, there were no significant differences between site of service for 90-day fractures, deep vein thromboses or pulmonary embolisms, infection, or hip dislocations. Hospital THAs had higher readmissions (P = .0003) and TKAs had higher 30-day emergency department visits (P = .005). ASC/HOPD patients were prescribed higher oral morphine equivalents (P < .0001, P < .0001; THA, TKA). Conclusions COVID's elective surgery shutdown caused a dramatic site of service shift. Traditional preoperative education was negatively impacted, and older and sicker patients became outpatients. But short-term complications were not increased in ASCs/HOPDs. These site of service and associated patient demographic changes may be safely sustained.
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Affiliation(s)
- Dexter Powell
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
| | - David Markel
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
- The Core Institute, Novi, MI, USA
| | | | - Stefano Muscatelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard Hughes
- MARCQI Coordinating Center, Ann Arbor, MI, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hallstrom
- MARCQI Coordinating Center, Ann Arbor, MI, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Frisch
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
- Department of Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI, USA
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Pincavitch JD, Pisquiy JJ, Wen S, Bryan N, Ammons J, Makwana P, Dietz MJ. Thirty-Day Mortality and Complication Rates in Total Joint Arthroplasty After a Recent COVID-19 Diagnosis: A Retrospective Cohort in the National COVID Cohort Collaborative (N3C). J Bone Joint Surg Am 2023; 105:1362-1372. [PMID: 37352338 PMCID: PMC11317089 DOI: 10.2106/jbjs.22.01317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND The risk of postoperative complications in patients who had a positive COVID-19 test prior to a total joint arthroplasty (TJA) is unknown. The purpose of this investigation was to study the complications and mortality associated with a recent COVID-19 diagnosis prior to TJA. METHODS Patients undergoing primary and revision total hip arthroplasties (THAs) or total knee arthroplasties (TKAs) were identified using the National COVID Cohort Collaborative (N3C) Data Enclave. Patients were divided into a COVID-19-positive group (positive polymerase chain reaction [PCR] test, clinical diagnosis, or positive antibody test) and a COVID-19-negative group, and the time from diagnosis was noted. There was no differentiation between severity or acuity of illness available. The postoperative complications reviewed included venous thromboembolism, pneumonia, acute myocardial infarction, readmission rates, and 30-day mortality rates. RESULTS A total of 85,047 patients who underwent elective TJA were included in this study, and 3,516 patients (4.13%) had had a recent positive COVID-19 diagnosis. Patients diagnosed with COVID-19 at 2 weeks prior to TJA were at increased risk of pneumonia (odds ratio [OR], 2.46), acute myocardial infarction (OR, 2.90), sepsis within 90 days (OR, 2.63), and 30-day mortality (OR, 10.61). CONCLUSIONS Patients with a recent COVID-19 diagnosis prior to TJA are at greater risk of postoperative complications including 30-day mortality. Our analysis presents critical data that should be considered prior to TJA in patients recently diagnosed with COVID-19. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jami D Pincavitch
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
| | - John J Pisquiy
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
| | - Sijin Wen
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Nicole Bryan
- Section of Infectious Diseases, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Jeffrey Ammons
- West Virginia Clinical & Translational Science Institute, West Virginia University, Morgantown, West Virginia
| | - Priyal Makwana
- Department of Scientific Computing and Data, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew J Dietz
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
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Santoro AJ, Post ZD, Thalody HS, Czymek MM, Ong AC, Ponzio DY. A Role for Outpatient Total Joint Arthroplasty During the COVID-19 Pandemic. Orthopedics 2023; 46:303-309. [PMID: 36921224 DOI: 10.3928/01477447-20230310-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Outpatient total joint arthroplasty (TJA) gained favor during the COVID-19 pandemic. Our objective was to critically evaluate the safety and short-term outcomes of outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) throughout the pandemic compared with pre-pandemic given their increased use. This was a retrospective review of 941 patients who underwent elective, outpatient TKA and THA at a single institution. Patients were divided into two cohorts: pre-pandemic (N=611) and pandemic (N=330). Data points included demographics, comorbidities, failure of same calendar day discharge (SCDD), and 90-day readmissions and re-operations. The pandemic cohort was older (61.0 vs 59.0 years; P=.001) and had a higher Charlson Comorbidity Index (2 vs 1; P=.004). There were no differences between the pandemic and pre-pandemic cohorts regarding SCDD failures (23.3% vs 21.9%; P=.623) and reoperations (4.2% vs 6.2%; P=.205). The pandemic cohort had a lower readmission rate (4.8% vs 8.2%; P=.056). Overall, patients who had failure of SCDD more commonly underwent TKA than THA (63.5% vs 36.5%; P<.001), were older (63.0 vs 58.5 years; P<.001), had a higher body mass index (30.8 vs 29.9 kg/m2; P=.006) and Charlson Comorbidity Index (2 vs 1; P<.001), had an American Society of Anesthesiologists class greater than 2 (51.2% vs 31.6%; P<.001), received physical therapy later postoperatively (4.15 vs 3.12 hours; P<.001), and had a history significant for myocardial infarction (P=.025), chronic kidney disease (P=.004), or diabetes (P=.003). This study supports broadening indications for outpatient TJA because we found a shift toward older patients with more comorbidities successfully undergoing the procedure. [Orthopedics. 2023;46(5):303-309.].
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Forlenza EM, Serino J, Weintraub MT, Burnett RA, Karas V, Della Valle CJ. Elective Joint Arthroplasty Should be Delayed by One Month After COVID-19 Infection to Prevent Postoperative Complications. J Arthroplasty 2023; 38:1676-1681. [PMID: 36813216 PMCID: PMC9941067 DOI: 10.1016/j.arth.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND It remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA). The purpose of this study was to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection. METHODS A large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders. RESULTS Multivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes. CONCLUSION COVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.
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Affiliation(s)
| | | | | | | | - Vasili Karas
- Rush University Medical Center, Chicago, Illinois
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Soloff MA, Keel T, Nizam A, Goldberg GL, Sakaris A, Diefenbach MA, DePeralta DK, Frimer M. Stress, anxiety, and illness perception in patients experiencing delay in operative care due to the COVID-19 pandemic. Gynecol Oncol Rep 2023; 48:101245. [PMID: 37576353 PMCID: PMC10422101 DOI: 10.1016/j.gore.2023.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Amid the height of the COVID-19 pandemic in the US, the US Surgeon General ordered hospitals and healthcare systems to stop all elective surgical procedures. The aim of our study was to evaluate the additional mental health impact of surgical delay on patients awaiting surgery for benign, pre-malignant and malignant conditions within the context of the COVID-19 pandemic. Study design All patients over the age of 18 awaiting surgery for benign, pre-malignant or malignant conditions within the gynecologic oncology, surgical oncology and colorectal services across Northwell Health were eligible for participation. Upon successful enrollment, participants completed a baseline questionnaire consisting of the Generalized Anxiety Disorder Questionnaire, the Penn State Worry Questionnaire, and Brief-Illness Patient Questionnaire. Results The surgical delay was considered moderately to extremely concerning by 72 % of survey respondents, with one third indicating the highest (10/10) level of concern. Fifty-five percent of patients with a pre-operatively suspected/confirmed cancer or pre-malignant condition demonstrated mild to severe anxiety in their completion of the GAD-7 scale. The average time awaiting surgery was 117 days (range 8-292); and 63 % of respondents indicated that the delay had a moderate to severe impact on their daily life. Conclusions Patients awaiting surgery for confirmed, suspected or pre-malignant conditions expressed decreased sense of control and increased levels of distress compared to patients awaiting procedures for benign conditions (p < 0.05, 95 % CI [-2.65, -0.08]). Future research will focus on the effects of COVID-19 related delays in operative care on clinical outcomes, including cancer morbidity and mortality.
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Affiliation(s)
- Michelle A. Soloff
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
| | - Trey Keel
- Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, United States
| | - Aaron Nizam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
| | - Gary L. Goldberg
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
- Karches Center for Oncology Research, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States
| | - Antoinette Sakaris
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
| | - Michael A. Diefenbach
- Department of Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, United States
| | - Danielle K. DePeralta
- Division of Surgical Oncology, Department of General Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
| | - Marina Frimer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 270-05 76 Avenue, Queens, NY 11040, United States
- Karches Center for Oncology Research, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States
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Patel TD, Coiado OC. Challenges with patient management of osteoarthritis during the COVID-19 pandemic: review. Ann Med Surg (Lond) 2023; 85:3925-3930. [PMID: 37554908 PMCID: PMC10406077 DOI: 10.1097/ms9.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
Osteoarthritis is a growing public health concern, affecting millions of people worldwide. With progressively worsening joint function and pain, management of osteoarthritis is important to ensure high quality of life for patients. Treatment includes a combination of pharmacologic agents and non-pharmacologic methods such as exercise and physical therapy. However, if multiple treatments fail to improve symptoms, joint replacement surgery is the final course of action. When the new coronavirus, SARS-CoV-2 (COVID-19), was declared a pandemic, all aspects of osteoarthritis treatment become affected. Due to increased public health measures, non-pharmacologic modalities and elective surgeries became limited in accessibility. Additionally, there were concerns about the interaction of current medications for osteoarthritis with the virus. As a result of limited options for treatment and quality of life of patients was negatively impacted, especially in those with severe osteoarthritis. Furthermore, a backlog of joint replacement surgeries was created which could take up to several months or years to address. In this review, we describe the impact COVID-19 had on osteoarthritis management as well as tactics to deal with the large caseload of surgeries as operative rooms begin to re-open for elective surgeries.
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Affiliation(s)
| | - Olivia Campos Coiado
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
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13
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Pedrozo VB, Schuroff GZ, Zaniolo FJ, Deeke M, Pedroni MA, Schuroff AA. Perception of Patients on the Waiting List for Total Hip Arthroplasty on the Resumption of Elective Surgeries during the COVID-19 Pandemic. Rev Bras Ortop 2023; 58:514-522. [PMID: 37396076 PMCID: PMC10310407 DOI: 10.1055/s-0043-1770151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/08/2022] [Indexed: 07/04/2023] Open
Abstract
Objective To analyze the profile and perception of patients on the waiting list for total hip arthroplasty (THA) about performing elective surgeries during the COVID-19 pandemic. Methods From July to November 2021, patients on the THA waiting list were interviewed during outpatient consultations. To compare the groups regarding categorical variables, the Chi-square test or Fisher's exact test was applied, and for quantitative variables the Mann-Whitney test was applied. The results were calculated using the Statistica program version 7. Results 39 patients answered the questionnaire. The mean age was 58.95 years, with 53.85% male. Approximately 60% expressed concern about contracting or transmitting COVID-19 to their family members after hospitalization for THA. 58.9% of patients felt hampered by the delay in scheduling elective surgeries during the pandemic. 23% lost or had a family member who lost their job during the pandemic, with a statistical difference for the group under 60 years old (p = 0.04). Conclusion Most patients were concerned about becoming infected and exposing family members to COVID-19 after surgery and noted damage due to suspensions and delay in scheduling elective surgeries. The economic impact of the pandemic was revealed by the rate of 23% of respondents who lost or had a family member who lost their job during the pandemic, being higher in patients under 60 years of age (p = 0.04).
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Affiliation(s)
- Vitor Bernardes Pedrozo
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Guilherme Zeni Schuroff
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Francisco José Zaniolo
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Mark Deeke
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Marco Antônio Pedroni
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Ademir Antônio Schuroff
- Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia do Hospital Universitário Cajuru, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang SB. Differences in Resumption of Orthopedic Surgery According to Characteristics of Surgery during COVID-19 Pandemic: National Registry Data. Clin Orthop Surg 2023; 15:327-337. [PMID: 37008965 PMCID: PMC10060775 DOI: 10.4055/cios22177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 04/04/2023] Open
Abstract
Background Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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15
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An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort Analysis. Arthroplast Today 2023; 20:101115. [PMID: 36776732 PMCID: PMC9905097 DOI: 10.1016/j.artd.2023.101115] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip and total knee arthroplasty. Methods This retrospective study split patients into cohorts: TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following the resumption of elective surgeries (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index, American Society of Anesthesiologists score, and pertinent comorbidities were analyzed, and length of stay, 30-day emergency department (ED) visit rates, readmissions, and reoperations were compared. Results A total of 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (interquartile range 63-76), and the post-COVID group had a median age of 68 years (interquartile range 61-75) (P = .024). SDD increased from 0.1% to 28.9% (P < .001), and length of stay decreased from 1.3 days to 0.89 days (P < .001). There was no change in 30-day ED visits, readmissions, or reoperations (P = .817, P = .470, and P = .643, respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P < .001, odds ratio [OR] = 0.94), body mass index (P = .006, OR = 0.95), male sex (P < .001, OR = 1.83), and history of tobacco use (P < .001, OR = 1.87). Conclusions At our institution, the COVID-19 pandemic accelerated the utilization of SDD pathways without increasing ED visits, readmissions, or reoperations.
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16
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Impact of COVID-19 on Clinical Outcomes Following Total Shoulder Arthroplasty. SEMINARS IN ARTHROPLASTY 2023; 33:416-421. [PMID: 37168077 PMCID: PMC9993730 DOI: 10.1053/j.sart.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Background The coronavirus (COVID-19) pandemic has introduced patient stressors and changes to perioperative protocols in total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term effects of the COVID-19 pandemic on various patient outcomes and satisfaction following elective TSA. Methods A retrospective review was performed on 147 patients who underwent primary TSA at a single institution between the June 2019 and December 2020. Patients were divided into two cohorts: pre-COVID (June 2019-March 2020; n=74) and post-COVID (April 2020-December 2020; n=73). No elective TSA were performed between 10 March 2020 and 23 April 2020 at our institution. Data were collected prospectively both pre- and postoperatively. Range of motion (ROM) testing included active abduction, internal (IR), and external rotation (ER). Patient reported outcome measures (PROMs) included global shoulder function, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain scoring systems, and patient satisfaction. ROM and PROMs were compared at preoperative, 3-month follow-up, and 12-month follow-up intervals. Operative time, length of stay (LOS), 90-day readmission, and 90-day reoperation were also compared. Results There were no differences in baseline patient characteristics. Operative time, LOS, home discharge rate, readmission, and reoperation did not differ between groups. For both cohorts, PROMs and ROM improved at each follow-up visit postoperatively. While preoperative abduction, IR, and ER were significantly greater in the post-COVID group, all ROM measures were similar at 3-month and 12-month follow-up visits. There was no difference in pain, global function, SST, ASES, or patient satisfaction between groups at all time intervals. Conclusions Patients undergoing elective TSA amidst the COVID-19 pandemic demonstrate excellent PROMs, ROM, and high satisfaction up to 12-months postoperatively that are comparable to pre-pandemic standards. Operative time, length of stay, discharge destination, as well as 90-day readmission and reoperation rates were not impacted by the pandemic. Patients can expect similar outcomes for TSA when comparing pre-COVID to post-COVID as the pandemic continues.
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Christensen TH, Singh V, Stambough JB, Barnes CL, Schwarzkopf R, Mears SC. Impact of the COVID-19 Pandemic on Patient Satisfaction After Total Joint Arthroplasty. Orthopedics 2023; 46:e105-e110. [PMID: 36476175 DOI: 10.3928/01477447-20221129-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic impacted the inpatient experience before and after total joint arthroplasty (TJA). This study aimed to examine how these changes affected patient satisfaction following TJA as recorded by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) postdischarge surveys and comments at 2 large academic institutions. A retrospective review identified patients who completed HCAHPS surveys following primary and revision TJA at 2 academic institutions: 1 in a predominately rural southern state (Institution A) and 1 in a northeastern metropolitan city (Institution B). Patients were grouped by discharge date: pre-COVID-19 (April 1, 2019, to October 31, 2019) or COVID-19 affected (April 1, 2020, to October 31, 2020). Differences in demographics, survey responses, and comment sentiments and themes were collected and evaluated. The number of HCAHPS surveys completed increased between periods at Institution A but decreased at Institution B (Institution A, 61 vs 103; Institution B, 524 vs 296). Rates of top-box survey responses remained the same across the 2 periods. The number of comments decreased at Institution B (1977 vs 1012) but increased at Institution A (55 vs 88). During the COVID-19-affected period, there was a significant increase in the negative comment rate from Institution B (11.6% vs 14.8%, P=.013) and a significant decrease in the positive comment rate from Institution A (70.9% vs 44.3%, P<.001). There was an increase in negative patient sentiments following TJA during the COVID-19 pandemic as seen in qualitative comments but not quantitative responses. This suggests that certain aspects of the TJA patient experience were impacted by COVID-19. [Orthopedics. 2023;46(2):e105-e110.].
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Abu-Awwad A, Tudoran C, Patrascu JM, Faur C, Tudoran M, Mekeres GM, Abu-Awwad SA, Csep AN. Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1640. [PMID: 36837270 PMCID: PMC9966432 DOI: 10.3390/ma16041640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Abu-Awwad
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Ilfov Str. Nr. 3, 030167 Bucuresti, Romania
| | - Jenel Marian Patrascu
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cosmin Faur
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Gabriel Mihai Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Andrei Nicolae Csep
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
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Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: propensity-matched analysis of a national surgical quality database. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:7. [PMID: 36759916 PMCID: PMC9910245 DOI: 10.1186/s42836-023-00163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There is currently no consensus regarding the optimal anesthetic technique for total hip and knee arthroplasty (THA, TKA). This study aimed to compare the utilization rates and safety of spinal vs. general anesthesia in contemporary THA/TKA practice. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a retrospective review of 307,076 patients undergoing total hip or knee arthroplasty under either spinal or general anesthesia between January 2015 and December 2018 was performed. Propensity matching was used to compare differences in operative times, hospital length of stay, discharge destination, and 30-day adverse events. The annual utilization rates for both techniques between 2011 and 2018 were also assessed. RESULTS Patients receiving spinal anesthesia had a shorter length of stay (P < 0.001) for TKA while no statistical differences in length of stay were observed for THA. Patients were also less likely to experience any 30-day complication (OR = 0.82, P <0.001 and OR = 0.92, P < 0.001 for THA and TKA, respectively) while being more likely to be discharged to home (OR = 1.46, P < 0.001 and OR = 1.44, P < 0.001 for THA and TKA, respectively). Between 2011 and 2018, spinal anesthesia utilization only increased by 1.4% for THA (P < 0.001) and decreased by 0.2% for TKA (P < 0.001), reaching 38.1% and 40.3%, respectively. CONCLUSION Spinal anesthesia remains a grossly underutilized tool despite providing better perioperative outcomes compared to general anesthesia. As orthopedic surgeons navigate the challenges of value-based care, spinal anesthesia represents an invaluable tool that should be considered the gold standard in elective, primary total hip and knee arthroplasty.
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An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020314. [PMID: 36837514 PMCID: PMC9961101 DOI: 10.3390/medicina59020314] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1-2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.
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Cole MW, Collins LK, Williams GH, Lee OC, Sherman WF. Keeping the Lights On: The Impact of the COVID-19 Pandemic on Elective Total Joint Arthroplasty Utilization in the United States. Arthroplast Today 2023; 19:101065. [PMID: 36373102 PMCID: PMC9637524 DOI: 10.1016/j.artd.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
Background It was estimated that up to 30,000 primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures would be cancelled each week during the moratorium on elective surgeries in the United States. The purpose of this study was to analyze the impact of the COVID-19 pandemic on elective total joint arthroplasty utilization in the United States. Methods A retrospective study was conducted using the PearlDiver database. Patients who underwent primary elective THAs and TKAs were identified and filtered by state and month from January through September of both 2019 and 2020. The volume of these procedures immediately following the moratorium on elective surgeries was compared to that of the same months the previous year. Results For THA, overall, there was a 27.39% reduction in volume from 2019 to 2020 in March and an 88.94% reduction in April. For TKA, overall, there was a 31.28% reduction in volume in March and a 96.61% reduction in April. When the states were separated into 2 cohorts by the 2020 presidential election vote, there was a significantly larger decrease in THA and TKA volume observed in the 25 states and Washington DC that voted democrat than that in the 25 states that voted republican in both March (P < .05) and April (P < .05). Both THA (118.29%) and TKA (101.02%) volume returned to prepandemic levels by June. Conclusions Overall, this study demonstrated that elective total joint arthroplasty utilization did reduce as anticipated following the CMS moratorium on elective surgeries but quickly returned to prepandemic levels by June. Level of Evidence Level III.
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Affiliation(s)
- Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Garrett H. Williams
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Olivia C. Lee
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA,Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA,Corresponding author. Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA. Tel.: +1 504 982 0252
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22
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The Effect of COVID-19 on Elective Total Knee Arthroplasty Utilization, Patient Comorbidity Burden, and Complications in the United States: A Nationwide Analysis. J Am Acad Orthop Surg 2022; 30:e1599-e1611. [PMID: 36107115 DOI: 10.5435/jaaos-d-22-00193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is one of the highest volume elective procedures done nationwide. Elective surgery was suspended because of the COVID-19 pandemic. The utilization trends, comparison of patient demographics, and postoperative outcomes in 2020 have yet to be evaluated substantially. We compared temporal trends in procedural volume, patient demographics, and postoperative complications of elective TKA in 2019 and 2020. METHODS Using a multicenter, nationwide representative sample, a retrospective query of the 2019 to 2020 American College of Surgeon's National Surgery Quality Improvement Program database was conducted for patients undergoing elective TKA. Temporal trends in utilization, demographics, and length of stay were compared pre-COVID-19 (2019 to 2020Q1) with post-COVID-19 (2020Q2 to Q4). Postoperative outcomes were compared by calendar year (2019 versus 2020). Linear regression was used to evaluate changes in procedural volume over time. A significance threshold of P < 0.05 was used. RESULTS A total of 121,415 patients underwent elective TKA in 2019 (N = 72,002) and 2020 (N = 49,413), a 31.4% decline. The proportion of hospital-defined "outpatient" TKAs in 2020 was significantly greater than that in 2019 (41.5% versus 25.5%; P < 0.001). Elective TKA utilization declined by 65.1% in 2020Q2 and never returned to prepandemic baseline in 2020Q3 to Q4. The average length of stay was shorter in 2020 (1.56 versus 1.87 days; P < 0.001). The proportion of same-day discharge increased each quarter from 2019Q1 to Q4 (6.2% to 8.6%) to 2020Q1 to Q4 (8.7% to 17.1%). Total complication rates were similar in 2019 (4.84%) versus 2020 (4.75%); P = 0.430. The 30-day mortality (0.08% versus 0.07%; P = 0.858), revision surgery (1.0% versus 1.0%; P = 0.940), and readmission (2.8% versus 2.6%; P = 0.053) rates were no different between 2019 and 2020. CONCLUSION Elective TKA declined during the second quarter of 2020. A large proportion of surgeries were transitioned to outpatient with rates of same-day discharge increasing over the study period, despite no change in complication, mortality, and readmission rates. Patient outcomes were not compromised despite pandemic restrictions for elective surgery. LEVEL OF EVIDENCE Level III.
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Gordon AM, Magruder ML, Ng MK, Sheth BK, Conway CA, Hang Jason Wong C. The combined effect of policy changes and the covid-19 pandemic on the same day discharge and complications following total hip arthroplasty: a nationwide analysis. ARTHROPLASTY 2022; 4:28. [PMID: 35909141 PMCID: PMC9340697 DOI: 10.1186/s42836-022-00131-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction As a result of the SARS-CoV-2 (COVID-19) pandemic in 2020, elective surgeries, including total joint arthroplasty (TJA), were suspended nationwide. Concurrent removal of total hip arthroplasty (THA) from the Medicare inpatient-only list posed challenges to the delivery of quality patient care with low payor cost. Therefore, the objective of this study was to compare temporal trends in patient demographics, case volumes, length of stay, and complications following elective THA in the years 2019 to 2020 in the United States. Methods The 2019 to 2020 ACS-NSQIP database was queried for elective THA patients. Patients Pre-COVID (2019 and 2020Q1) were compared with post-COVID (2020Q2-Q4). THA utilization, demographics, 30-day complications, and length of stay (LOS) were compared between years. Linear regression evaluated changes in case volumes over time with significance threshold of P < 0.05. Results A total of 77,797 patients underwent elective THA in 2019 (n = 43,667) and 2020 (n = 34,130), resulting in a 24.5% decline. Outpatient THA increased in 2020 (35.6%) vs. 2019 (5.7%) (P < 0.001). There was no significant difference in the volume of cases in 2019Q1 through 2019Q4 (P = 0.984). Elective THA volumes declined by 68.8% in 2020Q2, returned to pre-pandemic baseline in 2020Q3, before leveling off at 81.5% of baseline in Q4. Average LOS was significantly shorter in 2020 (1.55 days) vs. 2019 (1.78 days) (P < 0.001) and the proportion of same day discharge (SDD) increased quarterly from 2019 to 2020. There was no significant difference in the total complication rates in 2019 (6.6%) vs. 2020 (6.6%) (P = 0.831). Discussion Elective THA precipitously declined during the second quarter of 2020. The combined effect of policy changes and the COVID-19 pandemic resulted in a seven-fold increase in the number of surgeries performed in the outpatient setting in 2020. Rates of SDD doubled over the study period, despite no change in complication rates.
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Pizzarro J, Pakhchanian H, Tarawneh O, Liu I, Raiker R, Cohen JS, Malyavko A, Tabaie S, Thakkar S. The Impact of the COVID-19 Pandemic on Orthopaedic Knee Procedures: A National Multicentered Analysis. Cureus 2022; 14:e31681. [PMID: 36415473 PMCID: PMC9677421 DOI: 10.7759/cureus.31681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic strained the United States healthcare system, and associated policies resulted in the postponement or cancellation of many elective surgeries. While most orthopaedic surgeons are aware of how the pandemic affected their patients’ care, broader national trends in the operative treatment of orthopaedic knee pathology are poorly characterized. Therefore, the purpose of this study was to identify trends in orthopaedic knee procedures during the COVID-19 pandemic. Methods: The TriNetX database was queried for orthopaedic knee procedures performed from March 2018 to May 2021. Procedures were classified as arthroplasty (total knee arthroplasty (TKA), revision total knee arthroplasty) or non-arthroplasty (tendon or ligament repair, fracture fixation). Procedural volume per healthcare organization was determined over five seasons from March 2020 to May 2021 and compared to overlapping pre-pandemic periods from March 2018 to May 2019. Descriptive analysis was performed, and comparisons were made using a Student’s T-test. Results: Compared to the pre-pandemic period, there were significant decreases in primary TKA (p=0.016), femoral or entire tibial component revision TKA (p=0.005), and open treatment of femoral shaft fractures (p=0.007) in spring 2020. Procedural volume returned to baseline in summer 2020 through winter 2021. In spring 2021, primary TKA (p=0.017) and one component revision TKA (p=0.003) increased compared to the pre-pandemic period. Conclusion: The greatest decrease in knee procedures occurred early in the pandemic. Rates of these procedures have since rebounded, with some exceeding pre-pandemic levels. Hospitals are now better able to accommodate orthopaedic surgical volume while continuing to care for patients with COVID-19.
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Sybert M, Oakley CT, Christensen T, Bosco J, Schwarzkopf R, Slover J. Impact of COVID-19 Protocols on Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2022; 37:2193-2198. [PMID: 35598760 PMCID: PMC9119172 DOI: 10.1016/j.arth.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) after total hip arthroplasty (THA) is associated with increased morbidity, mortality, and healthcare expenditures. Our institution intensified hygiene standards during the COVID-19 pandemic; hospital staff exercised greater hand hygiene, glove use, and mask compliance. We examined the effect of these factors on SSI rates for primary THA (pTHA) and revision THA (rTHA). METHODS A retrospective review was performed identifying THA from January 2019 to June 2021 at a single institution. Baseline characteristics and outcomes were compared before (January 2019 to February 2020) and during (May 2020 to June 2021) the COVID-19 pandemic and during the first (May 2020 to November 2020) and second (December 2020 to June 2021) periods of the pandemic. Cohorts were compared using the Chi-squared test and independent samples t-test. RESULTS A total of 2,682 pTHA (prepandemic: 1,549 [57.8%]; pandemic: 1,133 [42.2%]) and 402 rTHA (prepandemic: 216 [53.7%]; Pandemic: 186 [46.2%]) were included. For primary and revision cases, superficial and deep SSI rates were similar before and during COVID-19. During COVID-19, the incidence of all (-0.43%, P = .029) and deep (-0.36%, P = .049) SSIs decreased between the first and second periods for rTHA. pTHA patients had longer operative times (P < .001) and shorter length of stay (P = .006) during COVID-19. Revision cases had longer operative times (P = .004) and length of stay (P = .046). Both pTHA and rTHA were discharged to skilled nursing facilities less frequently during COVID-19. CONCLUSION During COVID-19, operative times were longer in both pTHA and rTHA and patients were less likely to be discharged to a skilled nursing facility. Although intensified hygienic standards may lower SSI rates, infection rates did not significantly differ after our hospital implemented personal protective guidelines and a mask mandate.
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Affiliation(s)
| | | | | | | | | | - James Slover
- Address correspondence to: James D. Slover, MD, MS, Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health 301 East 17th Street, New York, NY 10003
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Oakley CT, Sybert M, Arraut J, Bosco J, Schwarzkopf R, Slover JD. Impact of Coronavirus Disease-2019 Protocols on Primary and Revision Total Knee Arthroplasty. Surg Infect (Larchmt) 2022; 23:841-847. [DOI: 10.1089/sur.2022.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian T. Oakley
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Michael Sybert
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jerry Arraut
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Joseph Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - James D. Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Gordon AM, Sheth B, Conway C, Magruder M, Sadeghpour R, Choueka J. The resiliency of elective total shoulder arthroplasty case volumes in the United States during the COVID-19 pandemic: a nationwide temporal trends analysis. J Shoulder Elbow Surg 2022; 31:e507-e517. [PMID: 35430366 PMCID: PMC9007746 DOI: 10.1016/j.jse.2022.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is one of the fastest growing procedures in terms of volume performed in hospitals in the United States. In 2020, elective surgery was suspended nationwide as a result of the SARS-CoV-2 (COVID-19) pandemic, and the use trends in the wake of the pandemic have yet to be evaluated substantially. Nationwide case volume reduction for TSA is unknown; therefore, the aim of this study is to compare patient demographics, complications, and temporal trends in case volume of elective TSA in the calendar year 2019 (prepandemic) to 2020 in the United States. METHODS Using a multicenter, nationwide representative sample from 2019 to 2020, a retrospective query was conducted for all patients undergoing elective TSA. Patients undergoing surgery pre-COVID (2019 and 2020 Q1) were compared to those during COVID (2020 Q2-Q4). Temporal trends in case volumes were compared between time frames. TSA use, patient demographics, complications, and length of stay were compared between years. Linear regression was used to evaluate for changes in the case volume over the study period. A statistical significance threshold of P <.05 was used. RESULTS In total, 9667 patients underwent elective TSA in 2019 (n = 5342) and 2020 (n = 4325). The proportion of patients who underwent outpatient TSA in 2020 was significantly greater than the year prior (20.6% vs. 13.9%; P < .001). Overall, elective TSA case volume declined by 19.0% from 2019 to 2020. There was no significant difference in the volume of cases in 2019 Q1 (n = 1401) through 2020 Q1 (n = 1296) (P = .216). However, elective TSA volumes declined by 54.6% in 2020 Q2. Elective TSA case volumes recovered to prepandemic baseline in 2020 Q3 and 2020 Q4. The average length of stay was comparable in 2020 vs. 2019 (1.29 vs. 1.32 days; P = .371), with the proportion of same-day discharge increasing per quarter from 2019 to 2020 (from 11.8% to 26.8% of annual cases). There was no significant difference in the total complication rates in 2019 (4.6%) vs. 2020 (4.9%) (P = .441). CONCLUSION Using a nationwide sample, elective TSA precipitously declined during the second quarter of 2020. Patient demographics of those undergoing elective TSA in 2020 were similar in comorbidity burden. A large proportion of surgeries were transitioned to the outpatient setting, with rates of same-day discharge doubling over the study period despite no change in overall complication rates.
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Affiliation(s)
- Adam M. Gordon
- Reprint requests: Adam M. Gordon, MD, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th St, Brooklyn, NY 11219, USA
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Deans CF, Buller LT, Ziemba-Davis M, Meneghini RM. Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience. Arthroplast Today 2022; 17:159-164. [PMID: 36158463 PMCID: PMC9493283 DOI: 10.1016/j.artd.2022.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background With hospital inpatient capacity increasingly limited and primary total joint arthroplasty (TJA) rapidly transitioning to outpatient settings, the feasibility of outpatient aseptic revision and conversion TJA (rTJA) has been considered. Before the widespread adoption of outpatient rTJA, guidelines must be established to prevent patient harm. To this end, this study describes our initial experience with same-day-discharge (SDD) aseptic rTJA. Methods All aseptic rTJAs performed between May 8, 2015, and December 30, 2021, were retrospectively reviewed. Revision indications, patient selection criteria, and outcomes including SDD success rate, predischarge complications, all-cause emergency department visits, inpatient readmissions, and unplanned clinic encounters within 90 days of surgery were recorded. Results Thirty-five SDD aseptic rTJAs were performed. Conversion total hip arthroplasty (55.0%) and instability (27.3%) were the most common indications for hip revision. Instability (50%) and conversion total knee arthroplasty (20.8%) were most common for knee revision. SDD was achieved in 97% (34/35) of cases. One hip patient failed SDD due to persistent hypoxia requiring an overnight hospital stay and also underwent closed reduction for dislocation in the emergency department within 90 days of discharge. Two additional patients had unplanned clinic encounters within 90 days of the index procedure. There were no hospital readmissions or reoperations within 90 days. Conclusions Our initial experience suggests SDD aseptic rTJA can be safe and effective when modern perioperative outpatient protocols and surgical techniques are implemented. Future studies should further define patient selection criteria to optimize outcomes and minimize complications in this population.
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Magruder ML, Gordon AM, Sheth BK, Conway CA, Wong CHJ. The effects of the COVID-19 pandemic on elective unicompartmental knee arthroplasty in the USA: further evidence that outpatient arthroplasty is safe and effective. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY 2022:10.1007/s00590-022-03393-x. [PMID: 36114876 PMCID: PMC9483408 DOI: 10.1007/s00590-022-03393-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/11/2022] [Indexed: 11/06/2022]
Abstract
Purpose In response to COVID-19, elective surgeries including unicompartmental knee arthroplasties (UKA) decreased. We aimed to quantify and compare temporal trends in utilization and complications in the calendar year 2019 (pre-pandemic) to 2020 in the USA. Methods The 2019 to 2020 ACS-NSQIP database was queried for patients undergoing elective UKA. Patients prior to COVID-19 (2019 and 2020 Q1) were compared to those after (2020 Q2-Q4). Case volumes, patient demographics, complications, and lengths of stay (LOS) were compared between years. Pearson’s chi-square test was used to compare patient demographics. Linear regression was conducted to evaluate the change in case volumes. P values less than 0.05 were significant. Results In total, 3361 patients underwent UKA: 1880 in 2019 and 1481 in 2020. The number of outpatient UKAs increased (56.4% vs. 65.6%; p < 0.001). There was no significant difference in the volume of cases in 2019Q1 through 2020Q1 (p = 0.424). Case volumes fell by 60% in 2020Q2 compared with the average quarterly volume in 2019. Comparing 2019 to 2020, there was no significant difference in rates of total complications (2.1% vs. 2.2%; p = 0.843), minor complications (1.2% vs. 0.9%; p = 0.529), major complications (1.1% vs. 1.4%; p = 0.447), infection complications (1.0% vs. 0.8%; p = 0.652), wound complications (0.1% vs. 0.1%; p = 1.0), cardiac complications (0.0% vs. 0.1%; p = 0.111), pulmonary complications (0.1% vs. 0.2%; p = 0.473), hematology complications (0.1% vs. 0.1%; p = 1.0), renal complications (0.1% vs. 0.0%; p = 1.0), and Clavien–Dindo IV complications (0.1% vs. 0.4%; p = 0.177). Conclusion UKA case volumes declined during the second quarter of 2020. A significant proportion of surgeries were transitioned outpatient, despite no change in complication rates.
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Pereira AM, Scopel FF, Oliveira SGDE, Almeida GDBDE, Moura CPDE. IMPACT OF MEASURES TO FIGHT THE PANDEMIC COVID-19 ON KNEE ARTHROPLASTIES IN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256089. [PMID: 36092179 PMCID: PMC9425923 DOI: 10.1590/1413-785220223004e256089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
Objective To assess the impacts of measures to face COVID-19 on total knee arthroplasty procedures in the country, based on data provided by the SUS Information and Informatics Department (DATASUS). Methods Cross-sectional study of secondary data in the public domain, available on the website of the Department of Information and Informatics of SUS (DATASUS), containing information about hospital admissions in the SUS. Results Brazil suffered a 51.82% decrease, on average, in the performance of total knee arthroplasty by the Unified Health System (SUS) in 2020, due to measures to face COVID-19. The analysis by region offers more details on this reduction in the number of procedures. In the Northeast, the decrease was on average 48.02%, whereas in the Center-West it was 65.61%. Southeast, North, and South registered an average decrease of 49.38%, 51.81%, and 55.06%, respectively. Conclusion COVID-19 impacted the realization of TKA in Brazil, with greater and lesser levels of decline observed in different Brazilian regions. In the Southeast region, for example, the states of São Paulo and Minas Gerais were the most affected, mainly due to the large population concentration, as well as Paraná, which has high numbers of procedures and a sharp decrease in 2020. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- André Miranda Pereira
- Hospital Santa Casa de Misericórdia de Vitória, Serviço de Ortopedia, Vitória, ES, Brazil
| | - Fábio Favarato Scopel
- Hospital Santa Casa de Misericórdia de Vitória, Grupo de Joelho, Vitória, ES, Brazil
| | | | | | - Cid Pereira DE Moura
- Hospital Santa Casa de Misericórdia de Vitória, Grupo de Joelho, Vitória, ES, Brazil
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Mirghaderi SP, Sheikhbahaei E, Salimi M, Mirghaderi SR, Ahmadi N, Moharrami A, Motififard M, Mortazavi SMJ. COVID-19 infection rate after urgent versus elective total hip replacement among unvaccinated individuals: A multicenter prospective cohort amid the COVID-19 pandemic. Ann Med Surg (Lond) 2022; 80:104307. [PMID: 35936568 PMCID: PMC9343069 DOI: 10.1016/j.amsu.2022.104307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022] Open
Abstract
Background Due to the COVID-19 pandemic, hospitals have become unsafe for patients as potential sources of virus transmission. This study aims to determine the COVID-19 infection rate after primary total hip arthroplasty (THA) among unvaccinated patients. THA patients undergoing elective or traumatic (urgent) THA were compared regarding COVID-19 contraction. Methods Primary THA patients were prospectively followed from three hospitals in *two great cities* of the country between April 2020 to August 2021. If the patient had suspected COVID-19 symptoms, had a SARS-CoV-2 PCR test from nasopharyngeal and oropharyngeal swabs and/or chest CT scan. Results Finally, information was received from 436 patients, including 345 (79.1%) elective and 91 (20.9%) traumatic THAs. Eight patients (1.8%) contracted COVID-19 within a month after THA discharge, and two died due to COVID-19. There was no statistical difference between COVID-19 disease and type of surgery (elective 1.4% versus traumatic 3.3%, P = 0.24). Women (Odds ratio (95% CI) = 8.5 (2.1–35.2), P = 0.01) and those who have heart disease (Odds ratio with Haldane-Anscombe correction ≈ 14.0, P = 0.01) were more likely to contract COVID-19 postoperatively. Conclusion In both elective and urgent cases of THA, researchers found that there is not a high risk of contracting the virus during the peri-surgery period. Urgent THA surgeries are comparable to elective THA-with those strict pre-elective surgery protocols-in terms of COVID-19 risk of infection from the hospital stay if appropriate health protocols are followed. The COVID-19 pandemic has made hospitals unsafe for elective surgeries. Eight patients (from 491, 1.8%) were infected with COVID-19 within a month of THA. Four were hospitalized due to severe symptoms. Three of 91 traumatic (3.3%) and five among 345 elective cases (1.4%) were infected. COVID-19 incidence is two-fold higher in urgent THA patients, but insignificant.
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COVID-19 Infection After Total Joint Arthroplasty Is Associated With Increased Complications. J Arthroplasty 2022; 37:S457-S464. [PMID: 35660197 PMCID: PMC8855291 DOI: 10.1016/j.arth.2021.10.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/27/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The impact of a postoperative diagnosis of COVID-19 in patients undergoing total joint arthroplasty (TJA) remains unknown. The objective of this study is to characterize the effect of COVID-19 infection following TJA on perioperative complication rates. METHODS The Mariner database was queried for patients undergoing total hip and total knee arthroplasty from January 2018 to April 2020. TJA patients who were diagnosed with COVID-19 within 90 days postoperatively were matched in a 1:3 fashion based on age, gender, iron deficiency anemia, payer status, and Charlson Comorbidity Index with patients who were not diagnosed with COVID-19. Preoperative comorbidity profiles and complications within 3 months of surgery were compared. Statistical analysis included chi-squared tests and multivariate logistic regression with outcomes considered significant at P < .05. RESULTS Of the 239 COVID-19 positive patients, 132 (55.2%) underwent total hip arthroplasty. On multivariate analysis, COVID-19 diagnosis was associated with increased odds of deep vein thrombosis (odds ratio [OR] 4.86, 95% confidence interval [CI] 2.10-11.81, P < .001), pulmonary embolism (OR 6.27, 95% CI 2.57-16.71, P < .001), and all complications (OR 3.36, 95% CI 2.47-4.59, P < .001). Incidence of deep vein thrombosis/pulmonary embolism was greater the closer in time the COVID-19 diagnosis was to the surgical procedure (10.24 times at 1 month, 7.87 times at 2 months, and 1.42 times at 3 months; P < .001). A similar relationship was observed with all complications. CONCLUSION Postoperative COVID-19 infection is associated with higher rates of cardiopulmonary complications, thromboembolic disease, renal injury, and urinary tract infections in patients undergoing hip and knee arthroplasty. COVID-19 infection earlier in the postoperative period is associated with a higher risk of complications.
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Bernstein JA, Rana A, Iorio R, Huddleston JI, Courtney PM. The Value-Based Total Joint Arthroplasty Paradox: Improved Outcomes, Decreasing Cost, and Decreased Surgeon Reimbursement, Are Access and Quality at Risk? J Arthroplasty 2022; 37:1216-1222. [PMID: 35158003 DOI: 10.1016/j.arth.2022.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Adam Rana
- Department of Orthopedics and Sports Medicine, Maine Medical Center, Portland, ME
| | - Richard Iorio
- Brigham and Women's Hospital, Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA
| | | | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Stronach BM, Zhang X, Haas D, Iorio R, Anoushiravani A, Barnes CL. Worsening Arthroplasty Utilization With Widening Racial Variance During the COVID-19 Pandemic. J Arthroplasty 2022; 37:1227-1232. [PMID: 35276272 PMCID: PMC8904006 DOI: 10.1016/j.arth.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Elective arthroplasty surgery in the United States came to a near-complete halt in the spring of 2019 as a response to the COVID-19 pandemic. Racial disparity has been a long-term concern in healthcare with increased focus during the pandemic. The purpose of this study is to evaluate the effects of COVID-19 and race on arthroplasty utilization trends during the pandemic. METHODS We used 2019 and 2020 Center for Medicare and Medicaid Service fee-for-service claims data to compare arthroplasty volumes prior to and during the COVID-19 pandemic. We compared overall arthroplasty utilization rates between 2019 and 2020 and then sought to determine the effect of race and COVID-19, both independently and combined. RESULTS There was a decrease in primary total knee arthroplasty (-28%), primary total hip arthroplasty (-14%), primary total hip arthroplasty for fracture (-2%), and revision arthroplasty (-14%) utilization between 2019 and 2020. The highest decrease in overall arthroplasty utilization was in the Hispanic population (34% decrease vs 19% decrease in the White population). We found that a non-White patient was 39.9% (P < .001) less likely to receive a total joint arthroplasty prior to COVID-19. The COVID-19 pandemic further exacerbated the pre-existing racial differences in arthroplasty utilization by decreasing the probability of receiving a total joint arthroplasty for non-White patient by another 12.9% (P < .001). CONCLUSION We found an overall decreased utilization rate of arthroplasty during the COVID-19 pandemic with further decrease noted in all non-White populations. This raises significant concern for worsening racial disparity in arthroplasty caused by the ongoing pandemic.
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Affiliation(s)
- Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR,Address correspondence to: C. Lowry Barnes, MD, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205
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SARPONG NO, KUYL EV, ONG C, CHIU YF, BOETTNER F, SU EP, RODRIGUEZ JA, DELLA VALLE AG. Reduction in hospital length of stay and increased utilization of telemedicine during the "return-to-normal" period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study. Acta Orthop 2022; 93:528-533. [PMID: 35694790 PMCID: PMC9189756 DOI: 10.2340/17453674.2022.2268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Elective total hip replacement (THR) was halted in our institution during the COVID-19 surge in March 2020. Afterwards, elective THR volume increased with emphasis on fast-track protocols, early discharge, and post-discharge virtual care. We compare early outcomes during this "return-to-normal period" with those of a matched pre-pandemic cohort. PATIENTS AND METHODS We identified 757 patients undergoing THR from June to August 2020, who were matched 1:1 with a control cohort from June to August 2019. Length of stay (LOS) for the study cohort was lower than the control cohort (31 vs. 45 hours; p < 0.001). The time to first postoperative physical therapy (PT) was shorter in the study cohort (370 vs. 425 minutes; p < 0.001). More patients were discharged home in the study cohort (99% vs. 94%; p < 0.001). Study patients utilized telehealth office and rehabilitation services 14 times more frequently (39% vs. 2.8%; p < 0.001). Outcomes included post-discharge 90-day unscheduled office visits, emergency room (ER) visits, complications, readmissions, and PROMs (HOOS JR, and VR-12 mental/physical). Mann-Whitney U and chi-square tests were used for group comparisons. RESULTS Rates of 90-day unscheduled outpatient visits (5.0% vs. 7.3%), ER visits (5.0% vs. 4.8%), hospital readmissions (4.0% vs. 2.8%), complications (0.04% vs. 0.03%), and 3-month PROMs were similar between cohorts. There was no 90-day mortality. INTERPRETATION A reduction in LOS and increased telehealth use for office and rehabilitation visits did not adversely influence 90-day clinical outcomes and PROMs. Our findings lend further support for the utilization of fast-track arthroplasty with augmentation of postoperative care delivery using telemedicine.
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Affiliation(s)
| | | | | | - Yu-Fen CHIU
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
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Mak IL, Wan EYF, Wong TKT, Lee WWJ, Chan EWY, Choi EPH, Chui CSL, Ip MSM, Lau WCS, Lau KK, Lee SF, Wong ICK, Yu EYT, Lam CLK. The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review. Public Health Rev 2022; 43:1604121. [PMID: 35574567 PMCID: PMC9091177 DOI: 10.3389/phrs.2022.1604121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders. Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found. Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future. Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.
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Affiliation(s)
- Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Teenie Kwan Tung Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wendy Woo Jung Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wallace Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Truong WH, Ramo B, Birch C, Dodwell E, Johnson M, Lebel DE, McIntosh A, Miller D, Snyder A, Sturm P, Guillaume T. Prioritizing Elective Surgical Cases During a Pandemic or Global Crisis: The Elective-Pediatric Orthopedic Surgical Timing (E-POST) Score. J Pediatr Orthop 2022; 42:e397-e401. [PMID: 35142719 DOI: 10.1097/bpo.0000000000002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND As the first wave of the COVID-19 pandemic stabilized and resources became more readily available, elective surgery was reinitiated and hospitals realized that there was little guidance on how to prioritize elective cases. METHODS A prioritization tool was formulated based on clinically relevant elements and previous literature. Nine pediatric orthopaedic surgeons from North American institutions evaluated 25 clinical scenarios on 2 occasions separated in time. Intra-rater and inter-rater reliability were calculated [intraclass correlation coefficient (ICC)]. Surgeons also ranked the importance of each element and how confident they were with scoring each factor. RESULTS Intra-rater ICC for total score showed good to excellent consistency; highest at 0.961 for length of stay (LOS) and lowest at 0.705 for acuity. Inter-rater ICC showed good to excellent agreement for American Society of Anesthesiologists score, LOS, duration of surgery, and transfusion risk and moderate agreement for surgical acuity and personal protective equipment (PPE) use. Transfusion risk and duration of surgery were deemed least important, and surgeons were least confident in scoring PPE and transfusion risk. Based on findings, the novel Elective-Pediatric Orthopedic Surgical Timing (E-POST) score for prioritizing elective cases was developed, consisting of 5 factors: surgical acuity, global health status, LOS, duration of surgery, and PPE requirement. CONCLUSIONS The E-POST numeric total score or subscore may help objectively prioritize elective cases during a global crisis. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Walter H Truong
- Gillette Children's Specialty Healthcare, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - David E Lebel
- Department of Orthopedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Dan Miller
- Gillette Children's Specialty Healthcare, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | | | - Peter Sturm
- Cincinnati Children's Hospital, Cincinnati, OH
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Peacock S, Wolfstadt J, Peer M, Gleicher Y. Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative. BMJ Open Qual 2022; 11:bmjoq-2021-001698. [PMID: 35318244 PMCID: PMC8943481 DOI: 10.1136/bmjoq-2021-001698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients. Methods This was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented. Results After implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days. Conclusion Our study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.
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Affiliation(s)
- Sharon Peacock
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Department of Surgery, Temerty Faculty of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
| | - Miki Peer
- Department of Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
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Helal A, Botros D, Qureshi F, Alhreish K, Dutcher L, Teel J, Dawkins J, Rizkalla J. Effects of the COVID-19 pandemic on hip fracture volume, disposition, and readmission rates. Proc AMIA Symp 2022; 35:444-446. [DOI: 10.1080/08998280.2022.2046418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Asad Helal
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - David Botros
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Coptic Medical Association of North America Research Institute
| | - Fahad Qureshi
- School of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Khalid Alhreish
- Department of Orthopedic Surgery, Texas A&M College of Medicine, Dallas, Texas
| | - Lincoln Dutcher
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jordan Teel
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jonathon Dawkins
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - James Rizkalla
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
- Coptic Medical Association of North America Research Institute
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Anthony CA, Rojas E, Glass N, Keffala V, Noiseux N, Elkins J, Brown TS, Bedard NA. A Psycholgical Intervention Delivered by Automated Mobile Phone Messaging Stabilized Hip and Knee Function During the COVID-19 Pandemic: A Randomized Controlled Trial. J Arthroplasty 2022; 37:431-437.e3. [PMID: 34906660 PMCID: PMC8665663 DOI: 10.1016/j.arth.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We conducted a randomized controlled trial to evaluate the effectiveness of acceptance and commitment therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip arthroplasty or total knee arthroplasty procedures postponed due to the COVID-19 pandemic. METHODS Ninety patients scheduled for total hip arthroplasty or total knee arthroplasty who experienced surgical delay due to the COVID-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimal clinically important differences (MCIDs) in preintervention and postintervention patient-reported outcome measures were utilized to evaluate the intervention. RESULTS Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System Physical Health compared to 17.5% in the control group (P = .038; number needed to treat [NNT] 5). For the joint-specific Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Knee Disability and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), 24% of the ACT group achieved MCID compared to 2.5% in the control group (P = .004; NNT 5). An improvement in the KOOS JR was found in 29% of the ACT group compared to 4.2% in the control group (P = .028; NNT 5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS JR compared to 41.7% in the control group (P = .027; NNT 4). CONCLUSION A psychological intervention delivered via a text messaging robot improved physical function and prevented decline in patient-reported outcome measures in patients who experienced an unexpected surgical delay during the COVID-19 pandemic. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Chris A. Anthony
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA,Address correspondence to: Chris A. Anthony, MD, Department of Orthopaedics, University of Pennsylvania, 800 Spruce Street, 1st Floor Cathcart Building, Philadelphia, PA
| | - Edward Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Valerie Keffala
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas Noiseux
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Jacob Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Timothy S. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas A. Bedard
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
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Current Status of Podcasts in Orthopaedic Surgery Practice and Education. J Am Acad Orthop Surg 2022; 30:141-147. [PMID: 34736272 DOI: 10.5435/jaaos-d-21-00856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023] Open
Abstract
Within orthopaedic surgery, podcasts are a popular medium for sharing information. The purpose of this Training Room feature was to identify the number, type, longevity, popularity, and advantages and disadvantages of orthopaedic surgery podcasts and to better understand the role of podcasts in our field by interviewing key leaders in orthopaedic surgery who host their own podcast. We identified 102 unique orthopaedic podcasts. The number of active podcasts grew from 5 in 2016 to 67 in 2021, which represents an increase of 1,340%. Podcasts offer the advantages of easy access to knowledge and opportunity for multitasking. They come with the disadvantages of lack of visualization in a field that relies heavily on diagrams, photographs, videos, and radiographs and lack of peer review, which means false information may be propagated. We anticipate an increase in the number and popularity of orthopaedic surgery podcasts in the coming years.
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COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10245908. [PMID: 34945204 PMCID: PMC8709337 DOI: 10.3390/jcm10245908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: “pre-COVID” (March 2019–March 2020; n = 263) and “post-COVID” (May 2020–March 2021; n = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, p = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, p = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, p = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, p = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, p = 0.745) or readmission rates (1.2 vs. 1.9%, p = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates.
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Patient Perspectives on the Cancellation of Elective Primary Hip and Knee Arthroplasty During the COVID-19 Pandemic. J Am Acad Orthop Surg 2021; 29:e1321-e1327. [PMID: 34874335 DOI: 10.5435/jaaos-d-20-00765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic resulted in the unprecedented widespread cancellation of scheduled elective primary total joint arthroplasty (TJA) in the United States. The impact of postponing scheduled total hip arthroplasty and total knee arthroplasty procedures on patients has not been well studied and may have physical, emotional, and financial consequences. METHODS All patients whose elective primary TJA procedures at a tertiary academic medical center were postponed because of COVID-19 were surveyed. Seventy-four patients agreed to answer 13 questions concerning the physical, mental, and financial impact of surgery cancellation. Statistical analysis, including Pearson correlation coefficients, cross-tabulation analysis, and chi squares, was performed. RESULTS 13.5% of patients strongly disagreed with the use of "elective" to describe their cancelled TJA surgery and 25.7% of patients reported substantial physical and/or mental deterioration due to postponement. Younger individuals experienced greater change in their symptoms (P = 0.034), anxiety about their pain (P = 0.010), and frustration/anger (P = 0.043). Poor quality of life, mood, and lower HOOS/KOOS Jr interval scores were correlated with greater financial strain, disagreement with the postponement, and disagreement with the use of "elective" to describe surgery. Disagreement with the use of "elective" to describe surgery was associated with greater financial strain (P = 0.013) and disagreement with the decision to postpone surgery (P = 0.008). In addition, greater financial strain was associated with disagreement with postponement (P = 0.014). CONCLUSION The cancellation of elective TJA during the COVID-19 pandemic had a variety of consequences for patients. One in four patients reported experiencing substantial physical and/or emotional deterioration. Associations of poor quality of life and mood with greater financial strain and disagreement with the term "elective" were seen. These results help quantify the deleterious effects of cancelling elective surgery and identify at-risk patients should another postponement of surgery occur. LEVEL OF EVIDENCE Level II-Prospective cohort study.
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Impact of the COVID-19 pandemic on orthognathic patients: What have we learned? Br J Oral Maxillofac Surg 2021; 60:629-634. [PMID: 35125246 PMCID: PMC8636306 DOI: 10.1016/j.bjoms.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022]
Abstract
Due to the COVID-19 pandemic orthognathic surgery was suspended in the UK. The effect this had on patients, to date, is unknown. A multi-centre, cross-sectional survey was conducted in the UK to investigate the health-related impact on patients on the orthognathic surgery pathway, including those on the waiting list for surgery. A structured questionnaire was designed to explore the impact of the pandemic on patients whose orthognathic treatment was temporarily cancelled. Ninety-five questionnaires were returned giving a response rate of 65%. When asked if the delay due to the pandemic had caused emotional distress, 63% (51/81) agreed. During the pandemic respondents experienced more distress in relation to dental appearance (60%, 51/83), self-confidence (52% 50/83), facial appearance (53%, 44/83), and ability to eat and chew (59%, 50/83). One hundred percent of patients would have appliances fitted or their appliances adjusted during the pandemic, and 93% stated that they would attend for surgery if they were offered this during the pandemic. In conclusion, patients appear to have experienced emotional distress in relation to the delay with their orthognathic treatment. They should be given greater priority during the remobilisation of elective surgery and should have access to ongoing psychological support when delays affect their treatment. The 'surgery-first' approach may be considered for suitable patients to minimise the duration of the treatment journey.
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Khow YZ, Liow MHL, Yeoh ZGF, Chen JY, Lo NN, Yeo SJ. A Weighted Scoring System Based on Preoperative and Long-Term Patient-Reported Outcome Measures to Guide Timing of Knee Arthroplasty. J Arthroplasty 2021; 36:3894-3900. [PMID: 34454804 DOI: 10.1016/j.arth.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is currently no existing consensus regarding timing of knee arthroplasty. This study aimed to develop a weighted scoring system from patient-reported outcome measures (PROMs) to guide timing of knee arthroplasty based on preoperative severity and long-term effectiveness. METHODS Prospectively collected data of 766 total knee arthroplasties (TKAs) and 382 unicompartmental knee arthroplasties (UKAs) at a single institution were analyzed. PROMs were assessed preoperatively and at 10 years using the Knee Society Score (KSS), Oxford Knee Score (OKS), and Short Form-36 physical component score (SF-36 PCS). Receiver operating characteristic analysis identified thresholds where preoperative PROMs predicted 10-year clinically meaningful improvements (minimal clinically important difference [MCID]). Threshold weights were assigned to PROMs based on their ability to predict MCID in isolation or in combination. RESULTS Poorer baseline PROMs predicted 10-year MCID attainments. The threshold of 49.5 points for the KSS, 30.5 points for the OKS, and 40.7 points for the SF-36 PCS and 55.5 points for the KSS, 33.5 points for the OKS, and 40.5 points for the SF-36 PCS was weighted 1 point for predicting MCID in 1 PROM for TKA and UKA, respectively. The threshold of 33.4 and 33.9 points for the SF-36 PCS was weighted 2 points for predicting MCID in 2 PROMs, whereas 29.3 and 31.3 points for the SF-36 PCS were weighted 3 points for predicting MCID in 3 PROMs for TKA and UKA, respectively. The sum of weighted components from 0 (lowest) to 5 (highest) represented likelihood for long-term benefits at 10 years. CONCLUSION This scoring system is a useful clinical adjunct for deciding timing of knee arthroplasty and prioritizing patients in institutions with long waitlists. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Low Incidence of Asymptomatic Positive Patients Detected During Preoperative Testing for Total Joint Arthroplasty During the COVID-19 Pandemic. J Am Acad Orthop Surg 2021; 29:e1217-e1224. [PMID: 33539060 DOI: 10.5435/jaaos-d-20-01213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/17/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although the pause in elective surgery was necessary to preserve healthcare resources at the height of the novel coronavirus disease 2019 (COVID-19) pandemic, recent data have highlighted the worsening pain, decline in physical activity, and increase in anxiety among cancelled total hip and knee arthroplasty patients. The purpose of this study was to evaluate the effectiveness of our staged reopening protocol and the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among elective arthroplasty patients. METHODS We identified all elective hip and knee arthroplasty patients who underwent our universal COVID-19 testing protocol during our phased reopening between May 1, 2020, and July 21, 2020, at our institution. We recorded the SARS-CoV-2 test results of each patient along with their demographics, medical comorbidities, and symptoms at the time of testing. We followed each of these positive patients through their rescheduled cases and recorded any complications or potential SARS-CoV-2 healthcare exposures. RESULTS Of the 2,329 patients, we identified five patients (0.21%) with a reverse transcription-polymerase chain reaction--confirmed SARS-CoV-2 positive test, none with symptoms. All patients were successfully rescheduled and underwent their elective arthroplasty procedure within 6 weeks of their original surgery date. None of these patients experienced a perioperative complication at the time of their rescheduled arthroplasty procedure. No orthopaedic surgeon or staff member caring for these patients reported a positive SARS-CoV-2 test. CONCLUSION Our phased reopening protocol with universal preoperative virus testing was safe and identified a low incidence of SARS-CoV-2 among asymptomatic, elective arthroplasty patients at our institution. With uncertainty regarding the trajectory of the COVID-19 pandemic, we hope that this research can guide future policy decisions regarding elective surgery.
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Robinson MG, Greene N, Katakam A, Chen A, Bedair HS, Humphrey T, Melnic CM. The effect of the COVID-19 pandemic on revision total hip and knee arthroplasty at a large academic hospital network. J Orthop 2021; 28:117-120. [PMID: 34840481 PMCID: PMC8610569 DOI: 10.1016/j.jor.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
We sought to quantify the impact of COVID-19 on canceled revision total joint arthroplasty (TJA) in a large academic hospital network. We performed a retrospective analysis of revision TKA and THA in a healthcare system containing 5 hospitals in a time period of 8 months prior to and 8 months after the cessation of elective surgery. We found a 30.1% decrease in revision TKA and a 6.80% decrease in revision THA. Revision TJA volume decreased in our healthcare system during COVID-19 compared to prior to the pandemic, which will likely have lasting financial and clinical ramifications for the healthcare system.
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Affiliation(s)
- Matthew G Robinson
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nattaly Greene
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Antonia Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Tyler Humphrey
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
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Impact and Strategies on Joint Surgery Centers without Lockdowns during the Peak of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study. J Clin Med 2021; 10:jcm10225392. [PMID: 34830674 PMCID: PMC8618289 DOI: 10.3390/jcm10225392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The real psychological impact of COVID-19 remains difficult to quantify and may differ between hospital sizes and levels. Taiwan’s response to COVID-19 differed in that it successfully prevented its spread, without implementing any lockdowns before May 2021. Patients’ fear would be the major reason for the reduction of surgeries. The daily data for patients who underwent total knee arthroplasty (TKA), total hip arthroplasty, and hemiarthroplasty were collected from two major joint surgery centers of a university hospital and a community hospital in Taiwan. Compared with the previous year, the initial impact of the pandemic evidently reduced the total number of patients (outpatient: 20–29%; admission: 22–37%; surgery: 18–35%) in both hospitals. During the study period, the total number of TKAs decreased by 56–61% in both hospitals. The reduction in arthroplasty surgeries was attributable to patients’ fear. Even with confirmed COVID-19 cases, the university hospital experienced less impact than the community hospital. The TKA was the most affected of all surgery types. Even without local epidemics and restrictions in Taiwan, the worldwide pandemic inevitably led to a reduction of approximately 60% of the total TKA operation volume, especially for community hospitals. The surgery scheduling strategies helped maintain the routine arthroplasty services.
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Laffont I, Gelis A, Balva C, Tavares I, Julia M, Pradalier F, Feuvrier F, Benhadid A, Fazilleau S, Masson J, Jourdan C, Dupeyron A, Duflos C. Interruption of outpatient follow-up in physical and rehabilitation medicine: Observational cross-sectional study of deleterious consequences of the first COVID-19 lockdown in France. Ann Phys Rehabil Med 2021; 64:101531. [PMID: 33933693 PMCID: PMC8084630 DOI: 10.1016/j.rehab.2021.101531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- I. Laffont
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France,Euromov, Digital Health in Motion, Montpellier University, Montpellier, France,Corresponding author
| | - A. Gelis
- Physical and rehabilitation medicine department, Propara, Montpellier, France
| | - C. Balva
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - I. Tavares
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - M. Julia
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France,Euromov, Digital Health in Motion, Montpellier University, Montpellier, France
| | - F. Pradalier
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - F. Feuvrier
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France,Euromov, Digital Health in Motion, Montpellier University, Montpellier, France
| | - A. Benhadid
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - S. Fazilleau
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - J. Masson
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - C. Jourdan
- Physical and rehabilitation medicine department, Montpellier University Hospital, Montpellier, France
| | - A. Dupeyron
- Euromov, Digital Health in Motion, Montpellier University, Montpellier, France,Physical and rehabilitation medicine department, Nîmes University Hospital, Nîmes, France
| | - C. Duflos
- Clinical Research and Epidemiology Unit, CHU de Montpellier University Montpellier, Montpellier, France
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Taylor AJ, Kay RD, Tye EY, Bryman JA, Longjohn D, Najibi S, Runner RP. Implementation of an enhanced recovery protocol at a safety net hospital : a silver lining to COVID-19? Bone Jt Open 2021; 2:871-878. [PMID: 34669504 PMCID: PMC8558442 DOI: 10.1302/2633-1462.210.bjo-2021-0072.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS This study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events. METHODS A retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits. RESULTS The mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively. CONCLUSION Through use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a 'silver lining' to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era. Cite this article: Bone Jt Open 2021;2(10):871-878.
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Affiliation(s)
- Adam J. Taylor
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Robert D. Kay
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Erik Y. Tye
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Jason A. Bryman
- Harbor-UCLA Medical Center, Torrance, California, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Donald Longjohn
- Harbor-UCLA Medical Center, Torrance, California, USA
- Department of Orthopaedic Surgery, Keck Hospital of USC, Los Angeles, California, USA
| | - Soheil Najibi
- Harbor-UCLA Medical Center, Torrance, California, USA
| | - Robert P. Runner
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
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