Impact of Covid-19 pandemic on arthroplasty services and early experience after resuming surgeries at a ‘non Covid’ center

Abstract

Background: The aim of this study is to assess the impact of Covid-19 crisis on hip and knee joint replacement surgeries at a high volume tertiary care hospital in the Indian National Capital Region and to evaluate the early experience of resumption of arthroplasty services. Methods: Institutional records of the arthroplasty cases, operated between 1st March to 31 August of 2019 (Group A, pre-Covid) and 2020 (Group B, pandemic year) were compared retrospectively over numerous parameters including the complications within six weeks of surgery. Results: There was a significant drop (by 82.53 %) in the total number of arthroplasty surgeries in Group B (62) as compared with Group A (355). Average number of arthroplasties per month were 59.17 ± 12.93 and 10.67 ± 13.29 in Group A and Group B respectively (p < 0.001). There was a significant increase in postoperative complication rate 7/355 (1.97 %) in Group A vs 7/62 (11.29 %) in Group B during pandemic (p < 0.002), along with a higher 30-days mortality rate 2/355 (3.22 %) vs 2/62 (0.56 %). Pandemic year also saw an increased readmission rate (4.83 %) vs (0.56 %) and postoperative ICU transfer rate (1.61 %) vs (0.56 %) in comparison with pre-Covid year. Conclusion: In the pandemic, arthroplasty services got severely affected at our center. With nearly six fold increase in complication rates, higher 30-days mortality and increased readmission rates, caution is advised in resuming arthroplasty surgeries without robust evaluation of cases. Whether undetected Covid-19 infection or poor pre-existing disease control due to lockdown can be linked to these results is a matter of further research with larger multicenter studies.

The Impact of the Coronavirus Disease 2019 Pandemic on US Total Knee and Hip Arthroplasty Procedures in 2020

“…April 2020 represented the greatest drop in monthly surgical volumes of primary TKA and THA. This is in line with studies of the early impact of COVID-19 in the US and abroad [ 5 , 15 , 16 ]. Revision procedures showed a more modest decline with just over half of revision knee and hip cases being lost, suggesting prioritization of higher acuity procedures.…”

The Impact of COVID-19 Pandemic on the Epidemiology of Hip and Knee Arthroplasty: A Two-Year Look into the Pandemic from A Single Tertiary Referral General Hospital in Indonesia

“…4,10 An 82.53% drop in arthroplasty was observed in an Indian study. 11 An Austrian study observed an 18.6% decrease in primary arthroplasty and 15.8% in revision arthroplasty. 12 In Romania, a decrease of up to 55.47% for primary and 69.14% for revision arthroplasty was reported.…”

“…This study is comparable to previous studies. 9,11,15 However, one study saw a rise in the readmission rate, which may correlate with the decreased recovery time. 11 Some studies, however, reported a contrasting result with an increase in the average length of hospital stay.…”

“…9,11,15 However, one study saw a rise in the readmission rate, which may correlate with the decreased recovery time. 11 Some studies, however, reported a contrasting result with an increase in the average length of hospital stay. 22 A study in Romania reported a comparable result in which the length of hospitalization decreased during the first-year pandemic and increased in the second year.…”

“…Studies worldwide have found significant decreases in arthroplasty procedures due to the pandemic. [4][5][6][7][8][9][10][11][12][13][14][15] As an orthopedic surgery requiring substantial contact between the surgeon and the patient, new protocols to reduce the infection have negatively impacted arthroplasty. 15 Postponement or cancellation of elective operations was rampant during the pandemic, alongside stricter procedures and guidelines.…”