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The COVID-19 pandemic in Singapore: what does it mean for arthroplasty?
Joshua Decruz1, Sumanth Prabhakar1, Benjamin Tze Kiong Ding1
1Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
Insights
Elective arthroplasty volumes significantly decreased during the COVID-19 pandemic, with careful planning enabling a gradual increase in essential procedures while maintaining patient safety. This study offers insights for reinstating surgeries as the pandemic evolves.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The Coronavirus Disease-19 (COVID-19) pandemic severely impacted global healthcare systems, leading to restrictions on elective procedures like arthroplasty.
- While elective, some arthroplasties are essential for managing debilitating pain and functional impairment, posing challenges during the pandemic.
- This study examines the experience of an Arthroplasty Division at the epicenter of the COVID-19 pandemic in Singapore.
Purpose of the Study:
- To describe the impact of the COVID-19 pandemic on arthroplasty volumes at a Singaporean institution.
- To correlate arthroplasty procedure numbers with COVID-19 case prevalence.
- To provide guidance for the safe reinstatement of elective arthroplasty procedures.
Main Methods:
- Review of COVID-19 case numbers (nationwide and institutional) from February 2020.
- Collating weekly arthroplasty volumes performed by the Division of Arthroplasty.
- Charting arthroplasty data against COVID-19 admissions and population prevalence.
Main Results:
- A 74% reduction in arthroplasty volume was observed during the pandemic (February-April), averaging 5 cases weekly.
- The lowest surgical volumes occurred early in the pandemic, gradually increasing to 47% of baseline.
- No COVID-19 infections were reported among orthopedic inpatients during the study period.
Conclusions:
- Careful planning and resource evaluation are crucial for managing surgical procedures during a pandemic.
- The study demonstrates a relationship between disease prevalence and achievable arthroplasty volumes, offering a potential guide for recovery phases.
- Dynamic re-evaluation is essential to balance patient safety, healthcare worker protection, and necessary surgical care.
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.
