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. 2023 Mar;5(2):151-158.
doi: 10.1016/j.jhsg.2022.12.004. Epub 2022 Dec 22.

Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases

Ivan Z Liu  1 , Jonathon Whitehead  1 , Madeleine Schlafly  1 , Haig Pakhchanian  2 , Rahul Raiker  3 , Mark C Snoddy  1
Affiliations

Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases

Ivan Z Liu et al. J Hand Surg Glob Online. 2023 Mar.

Abstract

Purpose: To quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery from 2020 to early 2022 at multiple centers.

Methods: In this retrospective comparative study, a real-time, national, federated research database was used to identify patients of interest from 56 health care organizations across the United States. Patients were queried from March 1, 2018, to February 28, 2022. Current Procedural Terminology codes were chosen using the Accreditation Council for Graduate Medical Education's hand fellowship procedure requirements.

Results: Common hand and wrist surgeries exhibited substantial fluctuations in procedural volume per health care organization during the COVID-19 pandemic. Time periods with considerable procedural volume decreases corresponded with surges in increased COVID-19 caseloads and emergence of COVID-19 variants. Periods of procedural volume increase occurred in the summer of 2020 and immediately following distribution of the COVID-19 vaccine to the public. Fixation of metacarpal fracture, fixation of phalangeal fracture, tendon transfer, flexor tendon repair, and extensor tendon repair consistently showed decreased volumes over the study period. In contrast, ulnar nerve decompression was the only procedure to experience a statistically significant increase in volume over an entire year (2021, +19.2%, P < .001), as compared to before the pandemic.

Conclusions: Major milestones of the COVID-19 pandemic correlated with fluctuations in the number of hand and wrist procedures performed across the United States. Future studies should seek to evaluate the impact of patient backlogs and individual procedure fluctuations on financial impacts, patient outcomes, and orthopedic trainee experience.

Type of study/level of evidence: Economic/Decision Analysis IV.

Keywords: COVID-19; Hand surgery; Orthopedic surgery; Procedural volume; Wrist surgery.

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Figures

Figure 1
Figure 1
Procedural trends during the COVID-19 pandemic. The figure shows an overlay of daily COVID-19 caseloads per day (bar graph, left-hand y axis), average total procedure volume per month per HCO (line graph, right-hand y axis), and notable COVID-19 milestones (vertical annotations). The x axis illustrates chronology, whereas the red and green shading indicate time pre- and postvaccine approval.
Figure 2
Figure 2
Selected seasonal procedure volumes. The figure shows a selection of individual procedures that consistently experienced either statistical decreases or increases in the mean procedural volume per HCO per pandemic season over the entire study period. Individual procedures that experienced both statistical increases and decreases in multiple successive seasons were not selected. Solid lines in each color represent the mean seasonal procedural volume per HCO during the pandemic, whereas the dotted lines of the same color represent the prepandemic mean seasonal procedural volume per HCO.
See this image and copyright information in PMC

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