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The Effect of the COVID-19 Orthopaedic Joint Surgery "Restart" on Patient Outcomes in Michigan
Harjot Uppal1, Simarjeet Puri1, Brian Hallstrom2
1Henry Ford-Providence Hospital Southfield, Southfield, MI, USA.
Insights
Total joint arthroplasty (TJA) volumes decreased during COVID-19. Post-pandemic TJA outcomes remained similar, suggesting surgeon training and established protocols ensured patient safety. The pandemic accelerated shifts in care settings.
Area of Science:
- Orthopaedic Surgery
- Public Health
- Epidemiology
Background:
- COVID-19 pandemic led to significant reductions in elective total joint arthroplasty (TJA) volume in Michigan.
- Local ordinances mandated temporary shutdowns of elective procedures, creating surgical gaps.
- Hypothesized that decreased volume and surgical interruptions would negatively impact TJA outcomes post-restart.
Purpose of the Study:
- To compare TJA outcomes following the COVID-19 pandemic restart with pre-pandemic data.
- To investigate the impact of pandemic-related surgical volume reduction on TJA outcomes.
Main Methods:
- Utilized the Michigan Arthroplasty Registry Collaborative Quality Initiative database.
- Analyzed outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) during the restart period.
- Compared outcomes to the preceding uninterrupted year.
Main Results:
- Significant reduction in THA and TKA surgical volume observed during the initial COVID-19 surge.
- Increased shift towards performing TJA in ambulatory surgery centers and hospital outpatient departments.
- Higher rates of discharge home with home care services for both THA and TKA.
- Slightly elevated deep vein thrombosis rates in early fall 2020, normalizing by late fall.
- No other significant differences in outcomes were noted.
Conclusions:
- Overall TJA outcomes remained similar after the pandemic restart.
- Suggests the robustness of orthopaedic surgeon training and established surgical pathways.
- The pandemic likely accelerated the trend towards changes in the site of service for TJA.
Background:
The COVID-19 pandemic significantly decreased elective total joint arthroplasty volume in Michigan. Depending on local ordinances, elective procedures were completely shut down for periods. We hypothesized that decreased volume and surgical gaps would impact outcomes once procedures restarted. This study compared outcomes of total hip and knee arthroplasty (TJA) following the COVID-19 pandemic restart.
Methods:
This study utilized the Michigan Arthroplasty Registry Collaborative Quality Initiative database to analyze outcomes for TJA compared to the previous uninterrupted year to investigate the effects of the pandemic on TJA outcomes.
Results:
As expected, there was a significant reduction in surgical volume for both total hip arthroplasty and total knee arthroplasty during the initial surge of COVID-19 cases in Michigan. There was a significant increasing shift toward performing TJA at ambulatory surgery centers and hospital outpatient departments. There was a significantly higher discharge home with use of home care services for both hips and knees. There was a slightly elevated rate of deep vein thrombosis among TJA patients within the early fall of 2020, which normalized to prepandemic levels by the fall. No other significant differences were noted.
Conclusions:
Overall, outcomes were similar after the resumption of TJA following the COVID-19 pandemic. Perhaps this is a test of the overall training of orthopaedic surgeons performing total hip arthroplasty/total knee arthroplasty and the application of well-established pathways. The pandemic likely promulgated the ongoing move for site of service change.
