An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania

Abstract

Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1–2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.

The Environmental Sustainability Assessment of an Orthopedics Emergency Hospital Supported by a New Innovative Framework

“…IA42 (waste recycling): The first step is the separation and management of waste, ensuring recycling and the circular economy. Reprocessing and reuse of external fixators, razors, blades, burs, and tourniquets is advisable in the orthopedic operating room [105]. Infectious medical waste is treated on site.…”

COVID-19 Infection Was Associated with the Functional Outcomes of Hip Fracture among Older Adults during the COVID-19 Pandemic Apex

“…Moldovan et al quantified the effects of COVID-19 on elective arthroplasty interventions in Romania. He found that the COVID-19 pandemic had a severe impact on the volume of elective arthroplasty cases in Romania’s 120 hospitals [ 9 ], and this impact had significant financial ramifications for the hospitals. The author proposed the development of new clinical procedures and personalized home recovery programs for future outbreaks.…”

“…The number of older adult patients presenting to hospitals with hip fractures was the same during the COVID-19 pandemic as it was before the pandemic, even in regions that experienced severe outbreaks of the virus [ 8 ]. Moldovan et al conducted a multicenter study in Romania in 2023 and found that the COVID-19 pandemic has had a severe impact on the volume of elective arthroplasty cases in Romania’s 120 hospitals, with a dramatic decrease in the volume of primary interventions for hip and knee patients of up to 69.14% and a corresponding decline in the quality of patient care [ 9 ]. The COVID-19 pandemic has influenced patterns of care and health outcomes among patients with hip fractures [ 10 ].…”

The Effect of the COVID-19 Pandemic on Early Adolescent Fractures in the Republic of Korea

“…As it seems natural that restrictions on physical activities would affect the musculoskeletal system, a number of studies have investigated the impact of the COVID-19 pandemic in the orthopedic field. It has been shown that the incidence of orthopedic diseases, including fractures of various sites, decreased during the pandemic, especially at the beginning of the outbreak, although the extent of change differed [ 14 , 15 , 16 , 17 ]. Many studies have also shown that the volume of surgical treatment has decreased during this period, as elective surgeries were delayed [ 17 , 18 ].…”

“…It has been shown that the incidence of orthopedic diseases, including fractures of various sites, decreased during the pandemic, especially at the beginning of the outbreak, although the extent of change differed [ 14 , 15 , 16 , 17 ]. Many studies have also shown that the volume of surgical treatment has decreased during this period, as elective surgeries were delayed [ 17 , 18 ]. Some later studies have shown that the total volume of orthopedic surgery sprung back as COVID-19 continued; however, this is mostly because of the surgeries that could not be postponed any longer [ 19 ].…”