No time to waste; the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark

Abstract

Aims This study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID-19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists. Methods All hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Register, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity. Results During COVID-period, fewer arthroplasties were performed than expected (Netherlands: 20%; Denmark: 5%), with the lowest O/E in April. In the Netherlands, more acute indications were prioritized, resulting in more American Society of Anesthesiologists grade III to IV patients receiving surgery. In both countries, no other patient prioritization was present. Relatively more arthroplasties were performed in private hospitals. There were no clinically relevant differences in revision arthroplasties between pre-COVID and COVID-period. Estimated total health loss depending on extra capacity ranged from: 19,800 to 29,400 QALYs (Netherlands): 1,700 to 2,400 QALYs (Denmark). With no extra capacity it will take > 30 years to deplete the waiting lists. Conclusion The COVID-19 pandemic had an enormous negative effect on arthroplasty rates, but more in the Netherlands than Denmark. In the Netherlands, hip and shoulder patients with acute indications were prioritized. Private hospitals filled in part of the capacity gap. QALY loss due to postponed arthroplasty surgeries is considerable. Cite this article: Bone Jt Open 2022;3(12):977–990.

Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic: systematic review and framework development

“…With other factors contributing to more cancellations (for example, climate change, strikes, supply interruptions), the current number is expected to be even higher. Although data are scarce for other countries, similar patterns are expected 4 , 5 .…”

The Impact of COVID-19 Pandemic on the Epidemiology of Hip and Knee Arthroplasty: A Two-Year Look into the Pandemic from A Single Tertiary Referral General Hospital in Indonesia

“…Studies worldwide have found significant decreases in arthroplasty procedures due to the pandemic. [4][5][6][7][8][9][10][11][12][13][14][15] As an orthopedic surgery requiring substantial contact between the surgeon and the patient, new protocols to reduce the infection have negatively impacted arthroplasty. 15 Postponement or cancellation of elective operations was rampant during the pandemic, alongside stricter procedures and guidelines.…”

Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries

“…COVID-19 caused by the SARS-CoV-2 virus had a tremendous effect on healthcare systems worldwide. Hospitals had to restructure to accommodate the influx of COVID-19 patients and prioritise acute care for non-COVID-19 patients, which disrupted orthopaedic care worldwide including reductions in elective and emergency surgical interventions,1–13 reduced clinic capacity3 4 6 10 12 and a decrease in orthopaedic trauma referrals and emergency admissions 6 7 12 14 15. Even more, the COVID-19 pandemic have led to an estimated total health loss for elective orthopaedic arthroplasty patients of approximately 30 000 QALYs, with decades of back-log of surgical capacity for these patients if capacity is not increased 13.…”

“…Hospitals had to restructure to accommodate the influx of COVID-19 patients and prioritise acute care for non-COVID-19 patients, which disrupted orthopaedic care worldwide including reductions in elective and emergency surgical interventions,1–13 reduced clinic capacity3 4 6 10 12 and a decrease in orthopaedic trauma referrals and emergency admissions 6 7 12 14 15. Even more, the COVID-19 pandemic have led to an estimated total health loss for elective orthopaedic arthroplasty patients of approximately 30 000 QALYs, with decades of back-log of surgical capacity for these patients if capacity is not increased 13. Many studies have described the impact of the COVID-19 pandemic on the volume of orthopaedic admissions,1–11 13 numbers of orthopaedic surgeries performed1–11 13 and the outcomes for COVID-19 patients admitted for orthopaedic care 16–20.…”

“…Even more, the COVID-19 pandemic have led to an estimated total health loss for elective orthopaedic arthroplasty patients of approximately 30 000 QALYs, with decades of back-log of surgical capacity for these patients if capacity is not increased 13. Many studies have described the impact of the COVID-19 pandemic on the volume of orthopaedic admissions,1–11 13 numbers of orthopaedic surgeries performed1–11 13 and the outcomes for COVID-19 patients admitted for orthopaedic care 16–20. However, the impact of the COVID-19 pandemic on the outcomes for non-COVID-19 orthopaedic patients and thereby the quality of orthopaedic care delivered during the COVID-19 pandemic at a global level, has not been well described.…”