The impact of the COVID-19 pandemic on the length of stay following total hip and knee arthroplasty in a high volume elective orthopaedic unit
Gemma Green, MBChB, BSc (hons), FRCS (Tr & Orth), ST8 Trauma and Orthopaedics, 1 Sarah Abbott, MBChB, MRCS, ST4 Trauma and Orthopaedics, 1 Yiannis Vyrides, MBChB, Junior Research Fellow, 2 Irrum Afzal, MICR, MRQA, MPH DIC, BSc (Hons), Research Manager, 2 Deiary Kader, MBChB, FRCS, FRCSEd, FRCSGlas, FRCS (Tr & Orth) MFSEM (UK), Consultant Orthopaedic and Trauma Surgeon, 2 and Sarkhell Radha, MBChB, Pg Cert, MBA, MSc, MRCS Ed, FRCS (Tr & Orth), Consultant Trauma and Orthopaedic Surgeon, Clinical Lead - Trauma and Orthopaedics 1 , 2Hip Knee
Aims
Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019. Length of stay is often recognized as a key marker of quality of care in patients undergoing arthroplasty. Expeditious discharge is key in establishing early rehabilitation and in reducing infection risk, both procedure-related and from COVID-19. The primary aim was to determine the effects of the COVID-19 pandemic length of stay following hip and knee arthroplasty at a high-volume, elective orthopaedic centre.
Methods
A retrospective cohort study was performed. Patients undergoing primary or revision hip or knee arthroplasty over a six-month period, from 1 July to 31 December 2020, were compared to the same period in 2019 before the COVID-19 pandemic. Demographic data, American Society of Anesthesiologists (ASA) grade, wait to surgery, COVID-19 status, and length of hospital stay were recorded.
Results
A total of 1,311 patients underwent hip or knee arthroplasty in the six-month period following recommencement of elective services in 2020 compared to 1,527 patients the year before. Waiting time to surgery increased in post-COVID-19 group (137 days vs 78; p < 0.001). Length of stay also significantly increased (0.49 days; p < 0.001) despite no difference in age or ASA grade. There were no cases of postoperative COVID-19 infection.
Conclusion
Time to surgery and length of hospital stay were significantly higher following recommencement of elective orthopaedic services in the latter part of 2020 in comparison to a similar patient cohort from the year before. Longer waiting times may have contributed to the clinical and radiological deterioration of arthritis and general musculoskeletal conditioning, which may in turn have affected immediate postoperative rehabilitation and mobilization, as well as increasing hospital stay.
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