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. 2022 Nov;37(11):2193-2198.
doi: 10.1016/j.arth.2022.05.035. Epub 2022 May 19.

Impact of COVID-19 Protocols on Primary and Revision Total Hip Arthroplasty

Michael Sybert  1 , Christian T Oakley  1 , Thomas Christensen  1 , Joseph Bosco  1 , Ran Schwarzkopf  1 , James Slover  1
Affiliations

Impact of COVID-19 Protocols on Primary and Revision Total Hip Arthroplasty

Michael Sybert et al. J Arthroplasty. 2022 Nov.

Abstract

Background: Surgical site infection (SSI) after total hip arthroplasty (THA) is associated with increased morbidity, mortality, and healthcare expenditures. Our institution intensified hygiene standards during the COVID-19 pandemic; hospital staff exercised greater hand hygiene, glove use, and mask compliance. We examined the effect of these factors on SSI rates for primary THA (pTHA) and revision THA (rTHA).

Methods: A retrospective review was performed identifying THA from January 2019 to June 2021 at a single institution. Baseline characteristics and outcomes were compared before (January 2019 to February 2020) and during (May 2020 to June 2021) the COVID-19 pandemic and during the first (May 2020 to November 2020) and second (December 2020 to June 2021) periods of the pandemic. Cohorts were compared using the Chi-squared test and independent samples t-test.

Results: A total of 2,682 pTHA (prepandemic: 1,549 [57.8%]; pandemic: 1,133 [42.2%]) and 402 rTHA (prepandemic: 216 [53.7%]; Pandemic: 186 [46.2%]) were included. For primary and revision cases, superficial and deep SSI rates were similar before and during COVID-19. During COVID-19, the incidence of all (-0.43%, P = .029) and deep (-0.36%, P = .049) SSIs decreased between the first and second periods for rTHA. pTHA patients had longer operative times (P < .001) and shorter length of stay (P = .006) during COVID-19. Revision cases had longer operative times (P = .004) and length of stay (P = .046). Both pTHA and rTHA were discharged to skilled nursing facilities less frequently during COVID-19.

Conclusion: During COVID-19, operative times were longer in both pTHA and rTHA and patients were less likely to be discharged to a skilled nursing facility. Although intensified hygienic standards may lower SSI rates, infection rates did not significantly differ after our hospital implemented personal protective guidelines and a mask mandate.

Keywords: complications; infection; periprosthetic joint infection; quality outcomes; revision; total hip arthroplasty.

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