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J Arthroplasty ; 36(7S): S56-S61, 2021 07.
Article in English | MEDLINE | ID: covidwho-1064844


BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic caused a massive disruption in elective arthroplasty practice in the United States that to date has not been quantified. We sought to determine the impact of COVID-19 on arthroplasty volumes in the United States, how this varied across the country, and the resultant financial implications. METHODS: We conducted a retrospective analysis of Medicare fee-for-service beneficiaries undergoing primary and revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) from January 1st through March 31st, 2020 with 74,080 TKAs and 54,975 THAs identified. We calculated the percent drop in average daily cases from before and after March 18, 2020. We then examined variation across states in arthroplasty case volumes as it related to reported COVID-19 cases, the impact of COVID-19 on length of stay and percentage of patients discharged home. Finally, we calculated the revenue impact on hospitals and surgeons. RESULTS: There was a steep decline in TKA and THA volumes in mid-March of 94% and 92%, respectively. There was a significant variation for arthroplasty case volumes across states. We found minimal change in length of stay except for primary THAs with fracture going from 5 + days to 4 days. We saw an increasing trend in discharge to home with the greatest effect in primary THAs with fracture. The total daily hospital Medicare revenue for arthroplasty declined by 87% and surgeon revenue decreased by 85%. CONCLUSION: The beginning of the COVID-19 pandemic caused a significant decrease in arthroplasty volumes in the Medicare population with a resultant substantial revenue loss for hospitals and surgeons.

Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Aged , Humans , Length of Stay , Medicare , Pandemics , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
Medicina (Kaunas) ; 57(1)2021 Jan 19.
Article in English | MEDLINE | ID: covidwho-1067761


The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.

Arthroplasty, Replacement, Hip/rehabilitation , Arthroplasty, Replacement, Knee/rehabilitation , COVID-19/epidemiology , Enhanced Recovery After Surgery/standards , Humans , Length of Stay/statistics & numerical data , Outcome and Process Assessment, Health Care , Postoperative Care/standards , Recovery of Function
J Arthroplasty ; 35(7S): S89-S94, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-243543


BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic poses an important risk to global health. METHODS: This study surveyed 370 international orthopedic surgeons affiliated with the American Association of Hip and Knee Surgeons to help identify the global impact of the COVID-19 pandemic on patient care. RESULTS: A total of 99 surgeons (27% of those surveyed) completed the questionnaire representing 32 different countries. Except for surgeons in Japan, all respondents noted that their practice had been affected to some degree and 70% of the surgeons have canceled elective procedures. More than a third of the surgeons have had to close their practices altogether and the remaining open practices were estimated to be sustainable for 7 weeks on average given their current situation. CONCLUSION: The COVID-19 pandemic has resulted in marked changes to the majority of international arthroplasty practices.

Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/prevention & control , Humans , Orthopedic Surgeons , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Surveys and Questionnaires