Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study

The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation.

All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents' health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered.

A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: -21.9% [-22.5;-21.4]; hip arthroplasty: -13.4% [-14.8;-12.0]; knee arthroplasty: -24.6% [-26.1;-23.0]; coronary angioplasty: -11.2% [-12.7;-9.7]) without any catch-up in the first half of 2021 (cataract surgery: -5.0% [-5.8;-4.3]; hip arthroplasty: -9.9% [-11.6;-8.2]; knee arthroplasty: -22.0% [-24.0;-20.1]; coronary angioplasty: -12,1% [-13.9;-10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (-2.6% [-4.9; -0.3]/+0.6 [-2.2; +3.4]).

This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine.