Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

Abstract

Background Although insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. COVID-19 negatively impacted access to care, while simultaneously widening pre-existing health care disparities. The purpose of the current study was to document this phenomena within orthopedics. Methods Patients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients undergoing arthroplasty prior to the pandemic (March 2020) and after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared. Results 269 (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher BMI, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. Comparing case volumes showed a larger decrease at ZSFGH compared to UCSF post-COVID. Wait times between the two sites pre- and post-COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH pre-COVID were more than double the wait times at UCSF post-COVID. Conclusions COVID-19 worsened access to primary hip and knee arthroplasty at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with non-private insurance were affected most.

Assessment of the dynamics of inpatient health care delivery in Poland before and throughout the COVID-19 pandemic

“…According to the literature review on orthopaedic services alone in the first phase of the pandemic, the number of elective operations, trauma procedures and outpatient visits decreased by 80%, 47% and 63%, respectively 33 . US study showed that COVID-19 decreased access to hip and knee arthroplasties and also worsened pre-existing disparities: most affected were non-English speakers and people without a private insurance were most affected 22 . Similar findings are presented in a study on the use of oncology and cardiology services in Italy in March 2020 34 .…”

Impacto da pandemia COVID-19 nos eventos tromboembólicos após artroplastia: revisão integrativa

“…Com a diminuição do pico da infecção da pandemia o número de pacientes à espera de artroplastia aumentou, com deterioração das condições clínicas e piora da qualidade de vida destes pacientes (Hanilton et al, 2022, Soriano & Toogood, 2022. Apesar dos desafios encontrados, hospitais públicos de Hong Kong continuaram fornecendo artroplastia àqueles pacientes de alta prioridade, com medidas de controle da contaminação (Lee et al, 2021).…”

Resiliency

“…While the pandemic is hopefully waning, this issue has 2 informative articles about the impact of COVID-19 on access to surgery and the effect of vaccination status on postoperative symptomatic COVID-19 after elective arthroplasty [ 2 , 3 ]. Other highlights include a study looking at the effectiveness of resorbable beads in treatment of infection with debridement and implant retention [ 4 ] and another article investigating patients’ perception of their scar after different surgical approaches for hip arthroplasty [ 5 ].…”