Introduction: The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits.
Methods: The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test.
Results: All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR.
Conclusion: There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.
Uvod: Namen študije je bil analizirati vpliv pandemije COVID-19 na ortopedskega pacienta in sicer na dostopnost operacij zamenjave kolka in kolena, smrtnost v 90 dneh po operaciji, čakalne dobe na te posege in obiske ortopedskih ambulant v Sloveniji.
Metode: Primerjali smo podatke bolnikov iz Registra endoprotetike Slovenije (RES), ki so imeli v pandemičnem letu 2020 opravljeno zamenjavo kolka in kolena v primerjavi s predhodnim letom 2019. Vzroke revizij in smrtnost v 90 dneh po operaciji smo primerjali s testom Hi-kvadrat, vrednosti števila operacij in čakalnih dob pa s primerjavo medianih vrednosti s 95-odstotnim intervalom zaupanja. Obiske ambulant smo primerjali z neparametričnim testom za odvisne vzorce – testom Wilcoxon Signed Ranked.
Rezultati: Število vseh operacij kolka in kolena, vključno s parcialnimi kolčnimi artroplastikami, se je zmanjšalo za 19 %, s 7.825 na 6.335. Število elektivnih primarnih totalnih kolčnih artroplastik se je zmanjšalo za 21 %, s 3.530 na 2.792. Število primarnih kolenskih artroplastik je padlo za 24 %, s 3.191 na 2.423. Število revizij kolčnih se je zmanjšalo za 10 %, revizij kolenskih endoprotez pa za 25 %. Razlik v 90-dnevni smrtnosti po operaciji nismo našli (p = 0,408). Obiski ambulant so se zmanjšali za 14 % z 228.682 na 196.582 letno. Čakalne dobe so se podaljšale za 56 dni (15 %) za artroplastiko kolka in 54 (12 %) za artroplastiko kolena.
Zaključek: Spomladi in jeseni se je število operacij in obiskov v ambulantah zaradi epidemije neizogibno zmanjšalo. Vendar smo z reorganizacijo ortopedske službe v Sloveniji v letu 2020 kljub pandemiji omogočili ohranitev števila kolčnih in kolenskih endoprotez na dokaj visoki ravni. Epidemiološki model, telemedicina in spodbujevalni mehanizmi za skrajševanje čakalnih dob bi lahko pomagali premagati vpliv epidemije na elektivne posege.
Keywords: 90-day mortality; COVID-19; hip replacements; knee replacements; outpatient clinics; waiting times.
© 2022 National Institute of Public Health, Slovenia, published by Sciendo.