Effect of coronavirus disease 2019 (COVID-19) on orthopaedic surgical volume

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Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted the American economy and healthcare system. The aim of our observational retrospective cohort study was to evaluate the short-term effect of orthopaedic surgical volume at a large tertiary care center. We hypothesized a slow resurgence in orthopaedic volume at our center. Methods: Orthopaedic surgical volume at a large tertiary care center was evaluated using the operating room schedule. Operative volume between January and August 2020 was compared with the previous year. All orthopaedic subspecialties including orthopaedic trauma, spine, oncology, pediatrics, adult reconstruction, and hand/upper extremity were included. Descriptive statistics and t-tests were utilized to compare monthly orthopaedic surgical volume. Results: In total, 8,170 procedures were completed between January–August 2019 (n=4,243) and 2020 (n=3,927). In March 2020, COVID-19 executive ordinances ceased all elective surgery. By April 2020, surgical volume had decreased 56.2% compared to April 2019; there was a severe decrease in adult reconstruction (−88.8%) and hand/upper extremity (−84.5%) volume, a substantial decrease in spine (−67.3%), foot and ankle (−58.1%), and pediatric (−49%) volume, a mild decrease to trauma (−23.7%), and an increase in tumor (+33%) surgical volume. After the COVID-19 ordinances were reversed in May 2020, surgical volume increased 79.7% compared to April 2020. By June 2020, every orthopaedic subspecialty had recovered to within 5% of 2019 levels. Orthopaedic trauma, adult reconstruction, upper extremity, spine, and foot monthly surgical volume in 2020 differed significantly from 2019 while pediatric orthopaedics and orthopaedic oncology did not differ significantly. Conclusions: The COVID-19 pandemic rapidly disrupted orthopaedic surgical volume differently by subspecialty, but we observed a robust recovery largely due to a backlog in cases and furloughs at smaller regional centers. Distressed healthcare organizations will likely consolidate further increasing surgical volume at large tertiary care centers. Orthopaedic surgeons should be mindful of these new trends and plan accordingly.

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