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Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery
Kylen K J Soriano1, Paul Toogood1
1Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
Insights
The COVID-19 pandemic worsened access to hip and knee replacement surgeries, increasing wait times and disparities for minority patients and those with non-private insurance.
Area of Science:
- Orthopedic surgery
- Public health
- Health equity
Background:
- Insurance status significantly impacts healthcare access, varying by race, age, and socioeconomic status.
- The COVID-19 pandemic exacerbated existing healthcare disparities and negatively affected access to care.
- Pre-existing disparities in orthopedic care access were investigated.
Purpose of the Study:
- To document the impact of COVID-19 on orthopedic care access.
- To analyze changes in surgical wait times and volumes post-pandemic.
- To identify patient populations most affected by pandemic-related access issues.
Main Methods:
- Retrospective review of hip and knee arthroplasty patients at two San Francisco medical centers (UCSF and ZSFGH).
- Comparison of pre-pandemic (before March 2020) and post-pandemic cohorts.
- Analysis of patient demographics, insurance status, surgical wait times, and operative volumes.
Main Results:
- A larger decrease in case volumes and a greater increase in wait times were observed at ZSFGH (safety-net hospital) compared to UCSF (tertiary center) post-COVID.
- Patients at ZSFGH were more likely to be racial minorities, non-English speakers, have higher BMI, and lack private insurance.
- Wait times at ZSFGH pre-COVID were more than double the wait times at UCSF post-COVID.
Conclusions:
- COVID-19 significantly worsened access to primary hip and knee arthroplasties.
- The pandemic amplified pre-existing healthcare disparities in orthopedic care.
- Racial minorities, non-English speakers, and patients with non-private insurance faced the most significant access challenges.
Background:
Although insurance status is important to patients' ability to access care, it varies significantly by race, age, and socioeconomic status. Novel coronavirus disease 2019 (COVID-19) negatively impacted access to care, while simultaneously widening pre-existing health-care disparities. The purpose of the present 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 who underwent arthroplasty before the pandemic (March 2020) and those after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.
Results:
Two-hundred sixty-nine (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 body mass index, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. A comparison of case volumes showed a larger decrease at ZSFGH than at UCSF after COVID. Wait times between the two sites before and after COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH before COVID were more than double the wait times at UCSF after COVID.
Conclusions:
COVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with nonprivate insurance were affected the most.
