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2.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 1705-1711, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1826407

ABSTRACT

PURPOSE: Due to the lack of evidence, it was the aim of the study to investigate current possible cutbacks in orthopaedic healthcare due to the coronavirus disease 2019 pandemic (COVID-19). METHODS: An online survey was performed of orthopaedic surgeons in the German-speaking Arthroscopy Society (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey consisted of 20 questions concerning four topics: four questions addressed the origin and surgical experience of the participant, 12 questions dealt with potential cutbacks in orthopaedic healthcare and 4 questions addressed the influence of the pandemic on the particular surgeon. RESULTS: Of 4234 contacted orthopaedic surgeons, 1399 responded. Regarding arthroscopic procedures between 10 and 30% of the participants stated that these were still being performed-with actual percentages depending on the specific joint and procedure. Only 6.2% of the participants stated that elective total joint arthroplasty was still being performed at their centre. In addition, physical rehabilitation and surgeons' postoperative follow-ups were severely affected. CONCLUSION: Orthopaedic healthcare services in Austria, Germany, and Switzerland are suffering a drastic cutback due to COVID-19. A drastic reduction in arthroscopic procedures like rotator cuff repair and cruciate ligament reconstruction and an almost total shutdown of elective total joint arthroplasty were reported. Long-term consequences cannot be predicted yet. The described disruption in orthopaedic healthcare services has to be viewed as historic. LEVEL OF EVIDENCE: V.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Orthopedics/statistics & numerical data , Pneumonia, Viral/epidemiology , Aftercare/statistics & numerical data , Arthroplasty/statistics & numerical data , Arthroscopy/statistics & numerical data , Austria/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Germany/epidemiology , Health Care Surveys , Humans , Internet , Male , Pandemics/statistics & numerical data , Pneumonia, Viral/virology , Rehabilitation/statistics & numerical data , SARS-CoV-2 , Switzerland/epidemiology
3.
J Arthroplasty ; 37(9): 1708-1714, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1767910

ABSTRACT

BACKGROUND: Provider-run "joint classes" educate total joint arthroplasty (TJA) patients on how to best prepare for surgery and maximize recovery. There is no research on potential healthcare inequities in the context of joint classes or on the impact of the recent shift toward telehealth due to coronavirus disease 2019 (COVID-19). Using data from a large metropolitan health system, we aimed to (1) identify demographic patterns in prepandemic joint class attendance and (2) understand the impact of telehealth on attendance. METHODS: We included data on 3,090 TJA patients from three centers, each with a separately operated joint class. Attendance patterns were assessed prepandemic and after the resumption of elective surgeries when classes transitioned to telehealth. Statistical testing included standardized differences (SD > 0.1 indicates significance) and a multivariate linear regression. RESULTS: The in-person and telehealth attendance rates were 69.9% and 69.2%, respectively. Joint class attendance was significantly higher for non-White, Hispanic, non-English primary language, Medicaid, and Medicare patients (all SD > 0.1). Age was a determinant of attendance for telehealth (SD > 0.1) but not for in-person (SD = 0.04). Contrastingly, physical distance from hospital was significant for in-person (SD > 0.1) but not for telehealth (SD = 0.06). On a multivariate analysis, distance from hospital (P < .05) and telehealth (P < .0001) were predictors of failed class attendance. CONCLUSION: This work highlights the relative importance of joint classes in specific subgroups of patients. Although telehealth attendance was lower, telehealth alleviated barriers to access related to physical distance but increased barriers for older patients. These results can guide providers on preoperative education and the implementation of telehealth.


Subject(s)
COVID-19 , Telemedicine , Aged , Arthroplasty , COVID-19/epidemiology , Humans , Medicaid , Medicare , United States
4.
J Arthroplasty ; 37(8): 1443-1447, 2022 08.
Article in English | MEDLINE | ID: covidwho-1734201

ABSTRACT

Moving THA off of the Inpatient Only (IPO) List for Center of Medicaid and Medicare Services (CMS) beneficiaries and the COVID-19 pandemic has caused a shift in delivery away from inpatient services and a decrease in demand. Medicare payments dramatically declined from 2019 to 2020. LOS decreases and shift to outpatient designations were accelerated by IPO list changes and COVID-19 issues. The percentage of SDD cases also increased. Other metrics favorable to decreased spending by CMS were increased discharge to home and decreased volume. These changes have a profound impact on surgeon-hospital relationships and surgeon compensation.


Subject(s)
Arthroplasty, Replacement, Hip , COVID-19 , Surgeons , Aged , Arthroplasty , COVID-19/epidemiology , Humans , Medicare , Pandemics , United States/epidemiology
5.
J Arthroplasty ; 37(7S): S449-S456, 2022 07.
Article in English | MEDLINE | ID: covidwho-1693926

ABSTRACT

BACKGROUND: After the COVID-19 pandemic declaration in March 2020, all the elective total joint replacement surgeries in Canada were abruptly canceled for an indefinite period of time. The principal objective of this study was to determine the prevalence of psychological morbidity experienced by arthroplasty surgeons during the peak of the first wave of the COVID-19 pandemic. Secondary objectives included characterizing influential variables affecting the surgeon's well-being and suggesting directives for improvement. METHODS: This study surveyed Canadian Arthroplasty Society (CAS) members regarding their psychological well-being using the validated General Health Questionnaire (GHQ-12), the Center for Epidemiological Studies Depression (CES-D) scale, and the Personal Wellbeing Index-Adult (PWI-A). As well, the survey included questions regarding concerns about COVID-19, precautionary measures, personal well-being, and sociodemographic characteristics. RESULTS: A total of 80 surgeons (52% of those surveyed) completed the questionnaire, representing all 10 provinces in Canada. The prevalence of emotional distress and depression were 38% and 29%, respectively. Psychological morbidity most commonly resulted from concerns of loss of income/operating time, experiences of emotional conflict, and generalized safety worries. The surgeons commonly (93%) demonstrated insight in recognizing the impact of COVID-19 on their emotional health. CONCLUSION: Canadian arthroplasty surgeons demonstrated emotional resilience and insight during COVID-19. Continual communication, as well as remuneration action plans, could improve the mental well-being of at-risk individuals.


Subject(s)
COVID-19 , Surgeons , Adult , Arthroplasty , COVID-19/epidemiology , Canada/epidemiology , Depression/epidemiology , Depression/etiology , Humans , Pandemics , SARS-CoV-2
6.
Jt Dis Relat Surg ; 32(1): 3-9, 2021.
Article in English | MEDLINE | ID: covidwho-1067912

ABSTRACT

OBJECTIVES: This study aims to investigate the effectiveness of a screening questionnaire to identify high-risk patients for novel coronavirus-2019 (COVID-19) among those undergoing elective orthopedic surgery. PATIENTS AND METHODS: Between May 4th, 2020 and June 11th, 2020, a total of 1,021 consecutive patients (492 males, 529 females; mean age: 62.3±15.1 years; range, 13 to 91 years) who were scheduled for elective orthopedic surgery were included. A screening questionnaire was applied to all patients. The patients admitted to hospital were also tested for COVID-19 infection through reverse transcription-polymerase chain reaction of the nasopharyngeal swab. RESULTS: Of the patients, 1,003 (98.2%) underwent elective surgery as planned. The screening questionnaire classified 30 patients as high-risk for COVID-19. A total of 18 procedures (n=18, 1.8%) were postponed due to the high risk of possible transmission of COVID-19. None of 991 low-risk patients were tested positive for COVID-19. CONCLUSION: The use of guiding principles for resuming elective orthopedic surgery is safe without a higher risk for complications in selected cases.


Subject(s)
Arthroplasty/statistics & numerical data , COVID-19 Testing , Elective Surgical Procedures/statistics & numerical data , Hospitalization , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Female , Germany/epidemiology , Hospitals, High-Volume , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Assessment , Surveys and Questionnaires , Young Adult
9.
Acta Orthop ; 91(5): 551-555, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-574903

ABSTRACT

Background and purpose - The ongoing Coronavirus Disease-19 (COVID-19) pandemic has taken a toll on healthcare systems around the world. This has led to guidelines advising against elective procedures, which includes elective arthroplasty. Despite arthroplasty being an elective procedure, some arthroplasties are arguably essential, as pain or functional impairment maybe devastating for patients, especially during this difficult period. We describe our experience as the Division of Arthroplasty in the hospital at the epicenter of the COVID-19 pandemic in Singapore.Patients and methods - The number of COVID-19 cases reported both nationwide and at our institution from February 2020 to date were reviewed. We then collated the number of arthroplasties that we were able to cope with on a weekly basis and charted it against the number of new COVID-19 cases admitted to our institution and the prevalence of COVID-19 within the Singapore population.Results - During the COVID-19 pandemic period, a significant decrease in the volume of arthroplasties was seen. 47 arthroplasties were performed during the pandemic period from February to April, with a weekly average of 5 cases. This was a 74% reduction compared with our institutional baseline. The least number of surgeries were performed during early periods of the pandemic. This eventually rose to a maximum of 47% of our baseline numbers. Throughout this period, no cases of COVID-19 infection were reported amongst the orthopedic inpatients at our institution.Interpretation - During the early periods of the pandemic, careful planning was required to evaluate the pandemic situation and gauge our resources and manpower. Our study illustrates the number of arthroplasties that can potentially be done relative to the disease curve. This could serve as a guide to reinstating arthroplasty as the pandemic dies down. However, it is prudent to note that these situations are widely dynamic and frequent re-evaluation is required to secure patient and healthcare personnel safety, while ensuring appropriate care is delivered.


Subject(s)
Arthroplasty/statistics & numerical data , COVID-19/epidemiology , Elective Surgical Procedures/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Singapore/epidemiology
10.
J Arthroplasty ; 35(7S): S85-S88, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-209264

ABSTRACT

BACKGROUND: As the world struggles with the COVID-19 pandemic, health care providers are on the front lines. We highlight the value of engaging in humanitarian medical work, contributions of the hip and knee arthroplasty community to date, and future needs after the resolution of the pandemic. We sought to understand how the arthroplasty community can contribute, based on historical lessons from prior pandemics and recessions, current needs, and projections of the COVID-19 impact. METHODS: We polled members of medical mission groups led by arthroplasty surgeons to understand their current efforts in humanitarian medical work. We also polled orthopedic colleagues to understand their role and response. Google Search and PubMed were used to find articles relevant to the current environment of the COVID-19 pandemic, humanitarian needs after previous epidemics, and the economic effects of prior recessions on elective surgery. RESULTS: Hip and knee arthroplasty surgeons are not at the center of the pandemic but are providing an invaluable supportive role through continued care of musculoskeletal patients and unloading of emergency rooms. Others have taken active roles assisting outside of orthopedics. Arthroplasty humanitarian organizations have donated personal protective equipment and helped to prepare their partners in other countries. Previous pandemics and epidemics highlight the need for sustained humanitarian support, particularly in poor countries or those with ongoing conflict and humanitarian crises. CONCLUSION: There are opportunities now to make a difference in this health care crisis. In the aftermath, there will be a great need for humanitarian work both here and throughout the world.


Subject(s)
Arthroplasty , Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delivery of Health Care , Elective Surgical Procedures , Humans , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
12.
J Arthroplasty ; 35(7S): S32-S36, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-143055

ABSTRACT

BACKGROUND: The economic effects of the COVID-19 crisis are not like anything the U.S. health care system has ever experienced. METHODS: As we begin to emerge from the peak of the COVID-19 pandemic, we need to plan the sustainable resumption of elective procedures. We must first ensure the safety of our patients and surgical staff. It must be a priority to monitor the availability of supplies for the continued care of patients suffering from COVID-19. As we resume elective orthopedic surgery and total joint arthroplasty, we must begin to reduce expenses by renegotiating vendor contracts, use ambulatory surgery centers and hospital outpatient departments in a safe and effective manner, adhere to strict evidence-based and COVID-19-adjusted practices, and incorporate telemedicine and other technology platforms when feasible for health care systems and orthopedic groups to survive economically. RESULTS: The return to normalcy will be slow and may be different than what we are accustomed to, but we must work together to plan a transition to a more sustainable health care reality which accommodates a COVID-19 world. CONCLUSION: Our goal should be using these lessons to achieve a healthy and successful 2021 fiscal year.


Subject(s)
Betacoronavirus , Coronavirus Infections , Elective Surgical Procedures/economics , Joints/surgery , Pandemics , Pneumonia, Viral , Arthroplasty , COVID-19 , Coronavirus Infections/epidemiology , Delivery of Health Care , Humans , Orthopedic Procedures , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine
13.
J Arthroplasty ; 35(7S): S42-S44, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-116774

ABSTRACT

BACKGROUND: The current coronavirus crisis, COVID-19, has affected all orthopedic surgeons. Surgeons at early stages of their career are at risk of being affected differently than their more established counterparts. METHODS: We conducted an online survey for members of the Young Arthroplasty Group to determine what effects this had on their current practice. RESULTS: Nearly 40% of our surveyed group responded ranging from residents, fellows, and early career surgeons. All groups had been affected by the crisis, with different impacts on each subgroup. CONCLUSION: COVID-19 had significant impact on young surgeons affecting their compensation, redeployment, and career advancement. Available resources should be offered to this group, where available, to mitigate the impact of the crisis.


Subject(s)
Arthroplasty , Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Age Factors , COVID-19 , Humans , SARS-CoV-2 , Surgeons , Surveys and Questionnaires
14.
J Arthroplasty ; 35(7S): S10-S14, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-97471

ABSTRACT

The COVID-19 pandemic has created widespread changes across all of health care. As a result, the impacts on the delivery of orthopedic services have been challenged. To ensure and provide adequate health care resources in terms of hospital capacity and personnel and personal protective equipment, service lines such as adult reconstruction and lower limb arthroplasty have stopped or substantially limited elective surgeries and have been forced to re-engineer care processes for a high volume of patients. Herein, we summarize the similar approaches by two arthroplasty divisions in high-volume academic referral centers in (1) the cessation of elective surgeries, (2) workforce restructuring, (3) phased delivery of outpatient and inpatient care, and (4) educational restructuring.


Subject(s)
Arthroplasty , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/prevention & control , Elective Surgical Procedures , Hospitals , Humans , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/prevention & control , Referral and Consultation , SARS-CoV-2 , Time Factors
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