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Hamersly JS, Deckard ER, Meneghini RM, Sonn KA. Trends in Preoperative Outcome Measures From 2013 to 2021 in Patients Undergoing Primary Total Joint Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-00955. [PMID: 38976555 DOI: 10.5435/jaaos-d-23-01173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/08/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION The prevalence of total joint arthroplasty (TJA) continues to increase exponentially. Patient-reported outcome measures (PROMs) are used to define clinical and quality-of-life improvement and for reimbursement. Temporal trends of preoperative PROMs and specifically how COVID-19 has affected these PROMs is lacking. This study evaluated preoperative PROMs over time, whether medical factors affected preoperative PROMs, and what correlations the COVID-19 pandemic had with these trends in PROMs. METHODS A total of 3,014 patients who underwent primary total hip total hip arthroplasty or total knee arthroplasty from 2013 to 2021 were retrospectively reviewed for covariates and preoperative PROMs. Commonly reported preoperative PROMs were evaluated in univariate and multivariate models. RESULTS Preoperative activity level steadily increased from 2015 to 2021 for THAs and steadily increased from 2015 to 2019 for TKAs, followed by a decrease in 2020. Preoperative KOOS JR scores increased from 2016 to 2019 and then decreased in 2020 and 2021. Preoperative knee pain with level walking and climbing stairs steadily increased from 2013 to 2019, with additional increases in 2020. The COVID-19 era was significantly associated with higher activity levels for THAs, higher levels of pain with level walking, and lower KOOS JR scores. Preoperative PROM scores demonstrated correlations with postoperative PROM scores, which differed from that during the COVID era (rho range 0.105 to 0.391) at a mean of 2.0 years postoperatively. DISCUSSION Surgical delays because of COVID-19 were associated with increased preoperative disability as evidenced by lower activity levels. Aside from this pandemic era, patient activity levels increased over time, indicating that modern TJA patients are more active preoperatively and likely to demand higher levels of function after surgery. Additional studies should evaluate the clinical effect of these statistically significant findings. Providers should consider the trends in preoperative PROMs over time when counseling patients on expectations after TJA.
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Affiliation(s)
- Jackson S Hamersly
- From the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Hamersly, Meneghini, Sonn), and the Indiana Joint Replacement Institute, Indianapolis, Indiana (Deckard, Meneghini)
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Wei Z, Xu Y, Feng B, Weng X. The impact of COVID-19 on hip and knee arthroplasty surgical volume in China. INTERNATIONAL ORTHOPAEDICS 2024; 48:49-56. [PMID: 37632527 DOI: 10.1007/s00264-023-05944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The reduction of hip and knee arthroplasty surgical volume has been reported in many countries during the COVID-19 pandemic. In China, there is no national joint registry system and the impact of COVID-19 towards surgical volume remains unclear. The aim of this study was to investigate the hip and knee arthroplasty surgical volume in China during the pandemic and evaluate its change trends. METHODS Annual sale numbers of prostheses used in total knee arthroplasty (TKA), total hip arthroplasty (THA), and femoral head replacement (FHR) from 2011 to 2021 was collected from providers registered in National Medical Products Administration (NMPA). Annual surgical volume of TKA, THA, FHR, unicompartmental knee arthroplasty (UKA), and revision of hip/knee arthroplasty (RJA) was collected from member hospitals of Beijing Joint Society (BJS). We used linear regression to estimate the loss of surgical volume. Annual surgical volume obtained from Britain and Australian joint registries were used to make comparison. RESULTS In China, the surgical volume of THA/FHR, TKA, and UKA in 2020 all decreased compared to the predicted value, with a reduction of 82,525 cases (13.46%), 165,178 cases (33.50%), and 151 cases (0.65%), respectively. All the three procedures showed significant recovery in 2021. The surgical volumes of THA/FHR and UKA were 68,813 and 9402 cases higher than predicted levels, respectively, while TKA volume remained slightly below the predicted level. The regional statistics in Beijing showed similar change mode. In 2020, the surgical volume of THA/FHR, TKA, FHR, and UKA all decreased compared to the predicted value, with a reduction of 5031 cases (43.37%), 5290 cases (40.69%), 620 cases (29.18%), and 925 cases (39.11%), respectively. In 2021, with the exception of FHR, the number of these procedures increased compared to 2020, but remained below the predicted value. Compared with the data from Britain and Australia, China experienced less reduction and faster recovery in the proportions of elderly people (> 65 years old) who undergo hip and knee arthroplasty during the COVID-19 pandemic. CONCLUSION During the COVID-19 pandemic, although hip and knee arthroplasty surgical volume in China showed a similar "restoration-recovery" change pattern with other countries, China took fewer losses in this field.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Yiming Xu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Penfold CM, Blom AW, Redaniel MT, Jones T, Eyles E, Keen T, Elliott A, Judge A. The impact of restricted provision of publicly funded elective hip and knee joints replacement during the COVID-19 pandemic in England. PLoS One 2023; 18:e0294304. [PMID: 38019830 PMCID: PMC10686417 DOI: 10.1371/journal.pone.0294304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Elective hip and knee replacement operations were suspended in April 2020 due to the COVID-19 pandemic. The impact of this suspension and continued disruption to the delivery of joint replacement surgery is still emerging. We describe the impact of the pandemic on the provision of publicly funded elective hip and knee replacement surgery at one teaching hospital in England and on which patients had surgery. METHODS We included all elective primary and revision hip and knee replacements performed at one hospital between January 2016 and June 2021. Using data for the years 2016-2019, we estimated the expected number of operations and beds occupied per month in January 2020 to June 2021 using time series linear models (adjusting for season and trend). We compared the predictions with the real data for January 2020 to June 2021 to assess the impact of the pandemic on the provision of elective hip and knee replacements. We compared the length of stay and characteristics (age, gender, number of comorbidities, index of multiple deprivation) of patients who had surgery before the pandemic with those who had surgery during the pandemic. RESULTS We included 6,964 elective primary and revision hip and knee replacements between January 2016 and June 2021. Between January 2020 and June 2021 primary hip replacement volume was 59% of predicted, and 47% for primary knee replacements. Revision hip replacement volume was 77% of predicted, and 42% for revision knee replacement. Median length of stay was one day shorter for primary (4 vs 3 days) and revision (6 vs 5 days) operations during the pandemic compared with before. Patients operated on during the pandemic were younger and had slightly more comorbidities than those operated on before the pandemic. CONCLUSIONS The restricted provision of elective hip and knee replacements during the COVID-19 pandemic changed the patient casemix, but did not introduce new inequalities in access to these operations. Patients were younger, had more comorbidities, and stayed in hospital for less time than those treated before the pandemic. Approximately half the number of operations were performed during the pandemic than would have been expected and the effect was greatest for revision knee replacements.
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Affiliation(s)
- Chris M. Penfold
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Maria Theresa Redaniel
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tim Jones
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily Eyles
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tim Keen
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Andrew Elliott
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Di Martino A. Observations on the Present and the Future of Hip Surgery. J Clin Med 2023; 12:jcm12103464. [PMID: 37240570 DOI: 10.3390/jcm12103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Each period in history has its own peculiar fashions and trends, and contemporary research on hip surgery is no exception [...].
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Sciences-DIBINEM, University of Bologna, 40136 Bologna, Italy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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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: 9] [Impact Index Per Article: 9.0] [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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Kocijan R, Stockinger T, Haschka J, Reichardt B, Resch H, Zwerina J, Behanova M. Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic. Bone 2022; 162:116477. [PMID: 35779846 PMCID: PMC9239920 DOI: 10.1016/j.bone.2022.116477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 06/25/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Caring for osteoporosis patients has proven challenging during the COVID-19 pandemic due to repeated lockdowns in Austria. The distinct possibility of insufficient treatment regimens is therefore a matter of pressing concern. The aim of the study was to assess alterations in dispensing anti-osteoporotic drugs during the COVID-19 pandemic. PATIENTS/METHODS This study was a nationwide retrospective register-based observational study which included all patients in Austria aged ≥50 who received at least one prescription for anti-osteoporotic medication between January 2016 and November 2020. Pseudonymised individual-level patients' data were obtained from social insurance authorities. Anti-osteoporotic agents were divided into: (i) oral bisphosphonates, (ii) intravenous bisphosphonates, (iii) selective estrogen receptor modulators (SERMs), (iv) teriparatide (TPTD) and (v) denosumab (DMAB). We used interrupted time series analysis with autoregressive integrated moving average models (ARIMA) to predict drug dispensing. RESULTS There were 2,884,374 dispensations of anti-osteoporotic drugs to 224,598 patients between 2016 and 2020. The mean monthly prescriptions for oral bisphosphonates (-14.5 %) and SERMs (-12.9 %) decreased during the COVID-19 pandemic when compared to the non-COVID-19 period. Dispensing for intravenous bisphosphonates (1.7 %) and teriparatide (9.5 %) increased. Prescriptions for DMAB decreased during the first lock-down, however increased by 29.1 % for the total observation time. The Arima models showed that in March 2020 (beginning of the 1st COVID-19 lockdown), there was a decrease of 778 dispensings, with a further increase of 14 dispensings every month for denosumab; a decrease by 178 dispensings, with a further increase of 23 dispensings every month for zolendronic acid; a decrease by 2950 dispensings, but with a further increase of 236 dispensings every other month for ibandronate and a decrease by 1443 dispensing with a further decrease of 29 dispensings for alendronate than predicted, had the lockdown not occurred. CONCLUSIONS The total number of prescriptions dispensed to patients treated with anti-osteoporotic medications declined rapidly during first COVID-19 lockdown. The observed decrease of DMAB during the first lockdown rebounded in the following months. Considering the massive treatment gap for osteoporosis, and the related fracture risk, clinicians should continue treatment, even during a pandemic.
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Affiliation(s)
- Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria
| | - Theresa Stockinger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria
| | - Judith Haschka
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Berthold Reichardt
- Austrian Social Health Insurance Fund, Österreichische Gesundheitskasse, Eisenstadt, Austria
| | - Heinrich Resch
- Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria; St. Vincent Hospital Vienna, 2nd Department of Internal Medicine, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria.
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Khan MM, Khawar H, Perkins R, Pardiwala A. The positive impact of GIRFT (getting it right first time) on arthroplasty services in times of COVID-19. Ann Med Surg (Lond) 2022; 77:103655. [PMID: 35479660 PMCID: PMC9022398 DOI: 10.1016/j.amsu.2022.103655] [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] [Received: 02/28/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 11/03/2022] Open
Abstract
Background Introduction Objectives Methodology Ethical approval and data consideration Results Conclusions Implementation of GIRFT (getting it right first time) guidelines at times of COVID 19 for arthroplasty services. Review of National Joint Registry (NJR) data in terms of contribution of arthroplasty services in post COVID world. Assessment of service structure of individual hospitals in terms of types of services involved. Recommendation for the future in terms of redistribution of service.
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Jemioło P, Storman D, Orzechowski P. Artificial Intelligence for COVID-19 Detection in Medical Imaging-Diagnostic Measures and Wasting-A Systematic Umbrella Review. J Clin Med 2022; 11:2054. [PMID: 35407664 PMCID: PMC9000039 DOI: 10.3390/jcm11072054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has sparked a barrage of primary research and reviews. We investigated the publishing process, time and resource wasting, and assessed the methodological quality of the reviews on artificial intelligence techniques to diagnose COVID-19 in medical images. We searched nine databases from inception until 1 September 2020. Two independent reviewers did all steps of identification, extraction, and methodological credibility assessment of records. Out of 725 records, 22 reviews analysing 165 primary studies met the inclusion criteria. This review covers 174,277 participants in total, including 19,170 diagnosed with COVID-19. The methodological credibility of all eligible studies was rated as critically low: 95% of papers had significant flaws in reporting quality. On average, 7.24 (range: 0-45) new papers were included in each subsequent review, and 14% of studies did not include any new paper into consideration. Almost three-quarters of the studies included less than 10% of available studies. More than half of the reviews did not comment on the previously published reviews at all. Much wasting time and resources could be avoided if referring to previous reviews and following methodological guidelines. Such information chaos is alarming. It is high time to draw conclusions from what we experienced and prepare for future pandemics.
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Affiliation(s)
- Paweł Jemioło
- AGH University of Science and Technology, Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, al. A. Mickiewicza 30, 30-059 Krakow, Poland;
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, ul. M. Kopernika 7, 31-034 Krakow, Poland;
| | - Patryk Orzechowski
- AGH University of Science and Technology, Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, al. A. Mickiewicza 30, 30-059 Krakow, Poland;
- Institute for Biomedical Informatics, University of Pennsylvania, 3700 Hamilton Walk, Philadelphia, PA 19104, 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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Barahona M, Infante CA, Palet MJ, Barahona MA, Barrientos C, Martinez A. Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year. Cureus 2021; 13:e17252. [PMID: 34422505 PMCID: PMC8370446 DOI: 10.7759/cureus.17252] [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] [Accepted: 08/17/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To analyze the impact of the coronavirus disease 2019 (COVID-19) outbreak during the first pandemic year in a single country. Methods A cross-sectional study was designed. The free access database of the Chilean Department of Statistics and Health Information (DEIS) was used to compare the number of orthopedic procedures between 2019 and 2020. Country mobility was exported from the Institute of Complex Engineering Systems (ISCI) free-access database; this corresponds to a direct measurement of the degree of confinement of the country. Spearman correlation (rho) was used to analyze the total monthly COVID infection trend and mobility to orthopedics procedures. Results The number of orthopedic surgeries fell by 22.8% during the first year of the pandemic. All surgical procedures were adversely affected, with the fracture/trauma surgeries being the least affected. The maximum adverse impact was seen in knee arthroplasty (-64%), followed by hip arthroplasty (-41%) and knee ligament reconstruction (-44%). The number of orthopedic procedures had a mild correlation to the monthly number of COVID-19 cases (rho=-0.53, p=0.08) and a strong correlation with the country's mobility (rho=0.94, p=0.0001). Conclusions The COVID-19 outbreak diminished the number of orthopedic procedures during 2020, and the impact was directly correlated to the country's mobility. The public health network did have a more significant adverse impact in elective surgeries due to a slower recovery than private institutions. An increase in the waiting list should be expected, which will widen the difference in access to orthopedic surgery in Chile.
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department/Knee Surgery, Clinica Bupa Santiago, La Florida, CHL.,Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Carlos A Infante
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Miguel J Palet
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Macarena A Barahona
- Orthopaedic Department, Hospital Clínico de la Universidad de Chile, Santiago, CHL
| | - Cristian Barrientos
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Alvaro Martinez
- Orthopaedic Department, Hospital Clínico de la Universidad de Chile, Santiago, CHL
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Dell'Isola A, Kiadaliri A, Turkiewicz A, Hughes V, Magnusson K, Runhaar J, Bierma-Zeinstra S, Englund M. The impact of first and second wave of COVID-19 on knee and hip surgeries in Sweden. J Exp Orthop 2021; 8:60. [PMID: 34389919 PMCID: PMC8363236 DOI: 10.1186/s40634-021-00382-7] [Citation(s) in RCA: 6] [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: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate the impact of COVID-19 in Sweden on rates of knee and hip surgeries. METHODS We used healthcare data for the population of the southernmost region in Sweden (1.4 million inhabitants). We did an interrupted time-series analysis to estimate changes in rates and trends of joint replacements (JR), arthroscopies, and fracture surgeries for knee or hip in April-December 2020 compared to pre-COVID-19 levels adjusting for seasonal variations. RESULTS We found a drop of 54% (95% CI 42%; 68%) and 42% (95% CI 32%; 52%), respectively, in the rate of JRs and arthroscopies in April 2020 when compared to the counterfactual scenario. This was followed by an increase that brought the rates of JRs and arthroscopies back to their predicted levels also during the beginning of the second wave (November-December 2020). Acute fracture surgeries were largely unaffected, i.e. did not show any decrease as observed for the other surgeries. CONCLUSIONS In southern Sweden, we observed a marked decrease in elective knee and hip surgeries following the first wave of Covid-19. The rates remained close to normal during the beginning of the second wave suggesting that important elective surgeries for patients with end-stage osteoarthritis can still be offered despite an ongoing pandemic provided adequate routines and hospital resources.
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Affiliation(s)
- Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Centre for Economic Demography, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Velocity Hughes
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Karin Magnusson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden.,Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
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