Authors (including presenting author) :
WC Fung, PK Chan, LS Lee, VWK Chan, A Cheung, MH Cheung, H Fu, CH Yan, KY Chiu
Affiliation :
Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong
Introduction :
In order to help containing the coronavirus disease 2019 (COVID-19) outbreak, many hospitals in Hong Kong have reduced elective surgeries to redeploy saved resources for handling healthcare challenges associated with COVID-19. Since the vast majority of joint replacement operations are elective procedures, joint replacement services in Hong Kong have been significantly disrupted.
Objectives :
(1) To review the impact of COVID-19 on surgical volume, hospitalizations and clinic attendances of patients with arthroplasty history; (2) To inform strategies to mitigate the impact of current and future pandemics.
Methodology :
In this retrospective comparative study, the “COVID-19 cohort” of patients who underwent elective total hip or knee replacement in Hong Kong public hospitals from January 1 to June 30, 2020 (The first wave and second wave of COVID-19) was compared with the “control cohort” during the same time period in 2019. Data analysis was performed to compare the two cohorts’ number of operations, hospital admissions, orthopaedic clinic attendances and waiting times.
Result & Outcome :
33,111 patient-episodes were analysed. During the study period, elective joint replacement operations and hospitalizations decreased by 52.5% and 53.6% respectively (p< 0.05). Reductions were most drastic from February to April, with surgical volume declining by 85.8% (p< 0.005). Primary arthroplasty operations decreased by 91.1% (p< 0.005) while revision operations remained similar. Nevertheless, 14 public hospitals continued performing elective joint replacements. Analysis of Queen Mary Hospital cases revealed that infection (27.8%) was the primary reason for surgery, followed by prosthesis loosening (22.2%) and progressive bone loss (16.7%). Orthopaedic clinic attendances decreased by 19.6% (p< 0.05). Increases were observed in waiting times and total number of patients on the waiting list for elective joint replacement.
The hospitals managed to maintain arthroplasty services for high-priority patients during COVID-19. However, there are only general guidelines are available in Hong Kong for case prioritization and criteria vary in different hospitals. There are international guidelines for case prioritization and infection control measures proposed by United Kingdom National Health Service and American College of Surgeons. Similar detailed guidelines for case prioritization and enhanced preoperative COVID-19 screening test for asymptomatic patients in arthroplasty should be considered to maintain essential services in Hong Kong.
