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.

Keywords: COVID-19; arthroplasty trends; coronavirus; elective hip surgery; elective knee surgery; length of hospital stay; orthopedics; pandemic; surgical volume.

Figure 1

(a) Monthly volume; and (b) 3-month moving average in period 1 January 2019–1 September 2022: cemented hip, uncemented hip, partial hip, hybrid and reverse hybrid, cemented knee, revision knee, and revision hip.

Figure 2

The scatterplot for variation of elective intervention volumes and the number of COVID-19 cases during the pandemic period in Romania. A polynomial curve fitting with an R square has been added to the scatterplot in order to show the correlation.

Figure 3

Three-month moving average of the monthly average length of hospital stays for: cemented hip-uncemented hip-cemented knee, partial hip, hybrid and reverse hybrid, revision knee-revision hip, for the interval 1 January 2019–1 September 2022.

Figure 4

(a) The three-month moving average of the ratio of inpatients to outpatient patients; (b) The three-month moving average of the average length of hospital programming.

Figure 5

Three-month moving average of the average monthly percentage of cases discharged at home for cemented hip-uncemented hip-cemented knee-partial hip-hybrid and reverse hybrid, respectively revision knee-revision hip, in the interval 1 January 2019–31 March 2022.

Figure 6

Hospitals revenues between 1 January 2019 and 1 September 2022.