Background:Before being evaluated by a physician, more than 50% of patients will search their symptoms on the Google search engine. In fact, Google was the engine used for nearly 90% of all online searches between 2016 and 2018. These search data are stored by Google and can be investigated through google extended trends for health (GETH). The goal of this research was to use GETH to correlate Google search probabilities for elective orthopaedic procedures with the orthopaedic surgeon density in each US state to create a surgical demand index (SDI) that could be then compared between states. In addition, this study aims to assess the effects of annual income, percent minority population, and unemployment rate on that SDI.Methods:Google search probabilities were collected using the Google Trends Extraction Tool. Search probabilities were collected in each state for composite search terms. Data were collected in monthly intervals between 2016 and 2018 and averaged. The states were grouped into geographic regions. One-way analysis of variance and pairwise Mann-Whitney U tests were done between these regions. Linear regression analysis was conducted to assess the effect of median annual statewide income, percent minority population, and unemployment rate with SDI.Results:The analysis of variance and Mann-Whitney U tests demonstrated a difference between regions. Linear regression analysis revealed a notable effect of median income on SDI, but no effect of percent minority population or unemployment rate.Conclusions:The Midwest and South had higher regional demand than the Northeast and West, with West Virginia being the most in need and the District of Columbia being the least in need. Annual median income had a notable negative effect on SDI, whereas percent minority population and unemployment rate had no effect. This study highlights the inequality that exists in the southern and midwestern United States and identifies one potential predictive factor of this unequal SDI.

Background: Several studies have demonstrated the decrease of public interest in elective orthopaedic surgeries throughout the beginning and middle of the COVID-19 pandemic, but none have assessed the return, if any, of public interest as the pandemic has progressed. Questions/Purpose: Apply a user-friendly tool and replicable methodology to (1) determine differential impacts of COVID-19 on search frequencies for exploratory and interventional search terms; (2) evaluate if public interest towards some common orthopaedic symptoms and their respective elective procedures have returned to pre-pandemic baseline. Method: Google search frequencies for common orthopaedic procedures and symptoms were extracted from Google Extended Trends for Health (GETH) between January 7th, 2018, and January 15th, 2022, using the Google Trends Information Extraction Tool. Queried terms were split into two categories: exploratory and interventional. Control limit analysis was performed for each search term to determine special cause variations and assess any recovery. Results: All search terms saw significant decreases the week of March 15th, 2020, and five of the six saw at least one more drop during the 2020 holiday season. Search volumes for exploratory terms initially fell less and recovered nearly four times faster compared to search volumes for interventional terms, but volatility of public interest was seen until the end of the study window. Conclusions: Public interest in elective orthopaedic procedures continues to be chaotic during this pandemic. This study is the first to assess the initial recovery of public interest in elective orthopaedic procedures in the COVID-19 era using a novel application of the Google Trends Information Extraction Tool and provides a timely update on changes in public perception as the pandemic has progressed. These results can be used to better understand, quantify, and potentially anticipate the interests of the national patient population and tailor care, public outreach programs, or policy based on real-time search trends.